创伤早期液体复苏终极标准的监控与探讨  

Study on the ultimate criteria of optimal goal in fluid resuscitation for severely traumatized patients

作　　者：田利华[1] 孙大炜[1] 白祥军[1] 廖忆刘[1] 周锡渊[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院创伤外科,武汉430030

出　　处：《中华急诊医学杂志》2010年第5期462-465,共4页Chinese Journal of Emergency Medicine

基　　金：基金项目：湖北省科技攻关基金资助项目（2005AA301C31）

摘　　要：目的研究创伤救治复苏的评价指标及影响因素，探讨创伤患者早期液体复苏的终极标准与监控效应。方法选择符合本项研究条件且需接受液体复苏者149例，采用损伤严重度评分（ISS）和急性生理学及慢性健康状况评分（APACHEII）对其组织损伤程度和伤后病情危害状况进行评价与分组，收集液体复苏前、复苏后及结束等不同时间段的心率、血压、血氧饱和度、血气、血乳酸及中心静脉血氧饱和度或混合静脉血氧饱和度等，并记录每小时尿量，对应时间段的碱缺失及氧合指数等，分别比较监控指标的组间差异、时间效应及并发症或与预后的关系等。结果救治24h实现终极标准的全身指标有127例，细胞指标有112例，两者平均恢复时间比较差异有统计学意义（P〈0．05）；各监测指标24h均实现终点目标者与〉24h或死亡者的APACHEⅡ分值比较差异具有统计学意义（P〈0．01）；并发症或死亡组实现终极目标的时间明显高于对照存活组，组间差异均有统计学意义（P〈0．05或P〈0．01）。结论创伤患者早期液体复苏不仅在于恢复生命体征的稳定，更重要是在血流动力学恢复正常的基础上，及时纠正组织灌流和细胞氧合不足，作为创伤救治复苏的终点目标。Objective To evaluate the physiological variables, which precisely and reliably reflected the effect of emergency fluid therapy for severely traumatized patients, in orter to set up the ultimate criteria of optimal goal in fluid resuscitation. Method A total of 149 patients with severe trauma were given fluid resuscitation and were stratified into 3 groups with different severities of trauma as per ISS （injury severity score） and APACHE II . Of all patients, heart rate （HR）, systolic blood pressure （SBP）, oxygen saturation of arterial blood （SaO2）, blood gas analysis, arterial blood lactate （ABL）, oxygen saturation of central venous bloed （SCVO2） or oxygen saturation of mixed venous blood （SVO2）, urine output, base excess （BE） and oxygenation index （OI = PaO2/FiO2） were measured and calculated. These variables were compared between groups to find out the significant differences and the relationship to response time to fluid therapy as well as complications and outcomes. Results Within 24 hours of fluid resuscitation, 127 patients reached the therapeutic goal in respect of systemic hemodynamics improved including the variables of SBP, HR and urine output, and the optimal goal of fluid therapy in 112 patients was estimated with cellular oxygen available found in the levels of ABL, BE and OI measured. These two sets of criteria （clinical signs vs laboratory findings） for determining the therapeutic goal showed significant difference in length of time taken for reaching the goal of treatment （ P 〈0.05）. There were significant differences in APACHE II scores between those reaching the therapeutic goal within 24 hours and those taking longer time over 24 hours reaching the therapeutic goal or the death （ P 〈 0.01）. The duration of persistence in abnormal systemic hemody-namics and laboratory findings was longer in patients with complications or injured to death than that in survivors （ P 〈 0.05 -0,01 ）. Conclusions In addition to the stability of vital signs, ti

关 键 词：创伤与损伤 液体复苏 监测 创伤评分 

分 类 号：R459.7[医药卫生—急诊医学]