限制性液体复苏治疗肺挫伤合并失血性休克的疗效评价  

Healing effect of limited fluid resuscitation on pulmonary contusion complicated with hemorrhagic shock

作　　者：严四军[1] 邓波荣[1] 刘燕[1] 曹祥[1] 黄洁健[1] 乔德成[1] 

机构地区：[1]解放军第161医院胸心外科,湖北武汉430010

出　　处：《临床军医杂志》2010年第3期354-356,共3页Clinical Journal of Medical Officers

摘　　要：目的探讨限制性液体复苏对肺挫伤合并失血性休克的治疗效果。方法 163例肺挫伤合并失血性休克病人随机分成充分液体复苏(常规)组(84例)、限制性液体复苏(限制)组(79例)。常规组在止血前早期、快速、足量补液,维持收缩压≥90mmHg(1mmHg=0.133kPa),中心静脉压(CVP)≥5cmH2O(1cmH2O=0.098kPa);限制组在止血前限制液体输入,维持收缩压在80～90mmHg,平均动脉压(MAP)在50～60mmHg,CVP在2～5cmH2O。比较两组患者的平均输液量、病死率及存活患者并发症的发生率。结果平均输液量常规组为(2650±525)ml,限制组为(1780±310)ml,两组比较差异有统计学意义(P<0.01)。常规组死亡20例(23.81%),限制组死亡9例(11.39%),常规组的病死率明显高于限制组(P<0.05)。且常规组存活患者并发急性呼吸窘迫综合征(ARDS)、多脏器功能障碍综合征(MODS)及总并发症的发生率也均高于限制组(P<0.05)。结论限制性液体复苏能降低肺挫伤合并失血性休克患者的病死率,并降低存活患者并发症的发生率,改善预后。Objective To evaluate the effect of limited fluid resuscitation on pulmonary contusion complicated with hemorrhagic shock.Methods A total of 163 patients with pulmonary contusion complicated with hemorrhagic shock were randomly divided into adequate fluid resuscitation group（n=84,regular group）and limited fluid resuscitation group（n=79,limited group）.In the regular group,the patients underwent fast infusion of the full quantity fluid in the early stage before hemostasia,and the systolic blood pressure was kept at ≥ 90 mmHg and central venous pressure（CVP）at ≥ 5cmH2O.In the limited group,fluid infusion was limited before hemostasia,keeping systolic blood pressure at 80-90 mmHg,mean arterial pressure（MAP）at 50-60 mmHg,and CVP at 2-5 cmH2O.Results Average transfusion volumes were（2650±525）ml in the regular group and（1780±310）ml in the limitied group,between which there was a significant difference（P〈0.01）.The mortality of the regular group was significantly higher than that of the limited group（P〈0.05）.Furthermore,the complication rate of the survival patients was higher in the regular group than in the limited group（P〈0.05）.Conclusion Limited fluid resuscitation can reduce the mortality of pulmonary contusion complicated with hemorrhagic shock,and the complications in the survivals.

关 键 词：肺挫伤 失血性休克 限制性液体复苏 并发症 

分 类 号：R655.3[医药卫生—外科学]