多发性创伤伴失血性休克复苏改良策略  

Multiple trauma with uncontrolled hemorrhagic shock recovery improvement strategy

作　　者：刘远飞[1] 刘向红[1] 张赣华[1] 周宇明[1] 

机构地区：[1]江西省赣州市人民医院,赣州341000

出　　处：《江西医药》2010年第12期1169-1172,共4页Jiangxi Medical Journal

摘　　要：目的探讨限制性液体复苏-高渗液体复苏-出血未控制前允许性低血压状态(即:复苏改良策略)对多发性创伤伴失血性休克的救治效果。方法复苏改良策略及常规复苏方法救治多发性创伤失血性休克患者78例,随机分为改良策略复苏组(46例),常规方法复苏组(32例),对2组患者复苏前后血流动力学指标、输入液体量、血清乳酸值、血气碱剩余值进行统计学分析,并比较两组住院期间ARDS、ARF的发生率和死亡率。结果改良策略复苏组液体输入量为(1866±357)ml,常规方法复苏组液体输入量为(3502±436)ml,2组比较差异有统计学意义(P<0.05);2组复苏前血乳酸值及碱剩余值比较差异无统计学意义(P>0.05),复苏24h后血乳酸值及碱剩余值比较差异有统计学意义(P<0.05);本研究治愈67例(85.9%),死亡11例(14.1%),发生ARDS 16例,ARF 8例,2组治愈率、死亡率、ARDS发生率比较差异有统计学意义。结论采用改良复苏策略在救治多发性创伤伴失血性休克患者方面,能有效地改善组织器官血液灌注,提高治愈率,降低死亡率,改善预后,治疗效果优于常规复苏方法。Objective To study the restrictive fluid resuscitation-high permeability fluid resuscitation-bleeding not controlling before allowing postural hypotension state（i.e.,recovery improvement strategies） for multiple trauma with uncontrolled hemorrhagic shock treatment of effect.Methods Resuscitation and conventional recovery method improvement strategies for treatment of multiple trauma patients with uncontrolled hemorrhagic shock 78 cases were randomly divided into improvement strategies recovery group（46 cases）,the conventional method recovery group（32 cases）,two groups of patients recovery around hemodynamic parameters,input liquid quantity,serum lactic acid value,flesh base excess values statistically analyzed,and compared between the two groups during hospitalization ARDS,the incidence and mortality of ARF.Results The improvement strategies recovery liquid inputs for group（1866 ±357） ml,the conventional method recovery liquid inputs for group（3502 ±436） ml,two groups of comparisons difference was statistically significant（P0.05）.Two groups of recovery blood lactic acid or alkali before residual value value comparative differences was not statistically significant（P0.05）,recovery 24 h after blood lactic acid or alkali surplus value value was statistically significant comparative differences（P0.05）.This study cure 67 cases（85.9%）,death in 11 patients（14.1%）,happen ARDS 16 cases,ARF in 8 cases,two groups of cure rate and mortality,ARDS incidence comparative differences with a statistical significance.Conclusion the improved recovery strategy in the treatment of multiple trauma patients with uncontrolled hemorrhagic shock aspect,can effectively improve tissue organ blood perfusion,improve the curative effect,reduces mortality and improving outcomes,the treatment effect is better than conventional recovery method.

关 键 词：失血性休克 限制性液体复苏 高渗盐 

分 类 号：R605.97[医药卫生—急诊医学]