胸腹联合伤合并创伤失血性休克的液体复苏治疗  

Effects of fluid resuscitation on thoracoabdominal injury combined with hemorrhagic traumatic shock

作　　者：范治伟[1] 路小光[1] 康新[1] 刘伟光[1] 王屹刚[1] 王丹[1] 庞洪刚[1] 

机构地区：[1]大连大学附属中山医院急诊医学科,辽宁省大连116001

出　　处：《中华急诊医学杂志》2007年第11期1128-1131,共4页Chinese Journal of Emergency Medicine

摘　　要：目的探讨延迟与即刻液体复苏对胸腹联合伤并创伤性休克患者的早期救治效果。方法回顾性分析2004年11月至2006年12月来院救治的98例胸腹联合伤并创伤性休克患者资料,所有病例均符合第五版《外科学》休克诊断标准。延迟复苏组(n=51),在到达手术室彻底止血前,只给予少量的平衡液维持机体基本需求;即刻复苏组(n=47),入院后快速给予大量等张晶体液和(或)胶体液。用成组t检验、方差分析或x^2检验分析两种液体复苏方式对血红蛋白含量、血小板计数、红细胞比容、血乳酸含量、碱缺失水平、术前复苏时间及病死率的影响。结果延迟复苏组与即刻复苏组输液量差异具有统计学意义[(1586±346)vs(3520±575)ml,P<0.01],但两组患者在手术前收缩压却差异无统计学意义[(78±29)mmHg vs(8l±24)mmHg,P>0.05]。术前血红蛋白[(106.21±20.91)g/L vs(89.10±32.42)g/L]、凝血酶原时间[(11.19±2.03)s vs(17.37±2.50)s]、血小板计数[(179.44±52.19)×10~9/L vs(105.55±50.67)×10~9/L]、红细胞比容[(28.40±2.31)% vs(20.84±2.58)%]、血乳酸[复苏30 min:(1.70±0.37)mmol/L vs(2.44±0.41)mmol/L;复苏60min:(3.16±0.42)mmol/L vs(5.73±0.68)mmol/L]和碱缺失[复苏30min:(-4.46±1.15)mmol/L vs(-5.78±1.15)mmol/L;复苏60min:(-5.46±1.29)mmol/L vs(-9.60±2.71)mmol/L],两组间差异具有统计学意义(P<0.05)。即刻复苏组术前复苏时间(73±29) min、病死率(18.9%),延迟复苏组术前复苏时间(58±26)min、病死率(11.3%),组间比较差异有统计学意义(P<0.05)。结论延迟液体复苏能显著改善胸腹联合伤并创伤失血性休克患者凝血功能、组织和器官的灌注及乳酸酸中毒程度,降低患者的病死率,缩短术前复苏时间,效果优于即刻液体复苏。Objective To study effects of fluid resuscitation on thoracoabdominal injury combined with hemorrhagic traumatic shock. Method A total of 98 patients, who were treated in Affiliated Zhongshan Hospital of Dalian University from November 2004 to December 2006, were retrospectively analyzed. The patients were diagnozed according to Surgery （fifth edition）. Patients were divided into delayed fluid resuscitation group （ n = 51） and immediate fluid resuscitation group （ n = 47）. Patients in delayed fluid resuscitation group were given with balanced salt solution for the body to maintain basic requirements. Patients in immediate fluid resuscitation group were rapidly administered with a lot of isotonic crystalloid and （or） colloid solution after admission. Hemoglobin, platelet count, hematocrit, blood lactic acid, basedeficit, preoperative resuscitation time and mortality were compared between the two groups. Paired t test and variance analysis or χ^2 test were used. Results The transfusion fluid volume of delayed group and immediate group was （ 1586 ± 346） ml, （3520 ± 575） ml, respectively, with P value 〈 0.01. There was no difference on systolic blood pressure between delayed group （78 ±29） mmHg and immediate group （81 ± 24） mmHg. There existed differences before operation on hemoglobin （106.21±20.91 vs 89.10±32.42 g/L）, prethrombin time （11.19±2.03 vs 17.37±2.50 s）, platelet count （179.44 ± 52.19）×10^9/L vs （105.55 ± 50.67）×10^9/L, hematocrit （28.40 ± 2.31）% vs （20.84 ±2.58）%, blood lactic acid （at 30 minutes after resuscitation： 1.70 ± 0.37 vs 2.44 ± 0.41 mmol/L; at 60 minutes after resuscitation： 3.16 ±0.42 vs 5.73 ±0.68 mmol/L）, basedeficit （at 30 minutes after resuscitation： - 4.46 ±1.15 vs - 5.78 ±1.15 mmol/L; at 60 minutes after resuscitation： - 5.46 ±1.29 vs - 9.60 ± 2.71 mmol/L）, the resuscitation time （58 ±26 vs 73 ±29） minutes, mortality was （ 11.3 vs 18.9） %. Conclusions Delayed fluid resuscitation c

关 键 词：胸腹联合伤 创伤 失血性休克 即刻液体复苏 延迟液体复苏 

分 类 号：R641[医药卫生—外科学]