妇产科失血性休克出血未控前限制性液体复苏的临床研究  

The value of restrictive liquid recovery in gynecology and obstetrics uncontrolled hemorrhagic shock

作　　者：徐敏娟[1] 刘远飞[2] 江海炜[1] 朱华勇[2] 

机构地区：[1]赣州市人民医院妇产科 [2]赣州市人民医院ICU,江西赣州341000

出　　处：《赣南医学院学报》2011年第4期560-562,共3页JOURNAL OF GANNAN MEDICAL UNIVERSITY

基　　金：2009年赣州市科技局立项课题;编号:200906266

摘　　要：目的:探索限制性液体复苏在妇产科失血性休克出血未控前治疗的应用价值。方法:87例妇产科失血性休克病人在来诊后均在5 m in内完成基本抢救,包括开通静脉补充血容量以逆转休克,维持循环功能并监测平均动脉压(MAP)、中心静脉压(CVP)、动脉血气、肝肾功能、HCT、Hb以指导休克复苏。随机分为两组,研究组46例采用限制性液体复苏措施,对照组41例采用常规液体复苏措施,监测两组患者的血乳酸(BL)、剩余碱(BE)、收缩压(SBP)、平均动脉压(MAP)复苏指标变化和治愈率、MODS、ARDS并发症发生率以及输液量。结果:研究组液体输入量为(1266±257)mL,对照组液体输入量为(2502±436)mL,两组比较差异有统计学意义(P<0.05);两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24 h后血乳酸值及碱剩余值比较差异有统计学意义(P<0.05);本研究中发生MODS 8例,ARDS 4例,ARF 6例,两组治愈率、死亡率、MODS、ARDS发生率比较差异有统计学意义。结论:采用限制性液体复苏在救治妇产科失血性休克时能有效改善组织器官的血流灌注,不至过多地扰乱机体内环境,改善预后,促进早期康复,减少并发症,具有一定的临床应用价值。Objective：To explore the value of restrictive liquid recovery in gynecology and obstetrics uncontrolled hemorrhagic shock.Methods：In 87 cases of gynecology and obstetrics in uncontrolled hemorrhagic shock,the basic rescue was done in 5 min,including opening vein blood capacity to reverse shock supplement,maintain circulation function and monitoring mean arterial pressure（MAP）,central enous pressure（CVP）,arterial blood gas,liver and kidney function,HCT,Hb to guide shock recovery.They were randomly divided into two groups,the Study Group of 46 cases by the restrictive measures and control fluid resuscitation,the Control Group of 41 cases with conventional fluid resuscitation,monitoring patients measures blood lactic acid（BL）,residual alkali（to BE）,systolic blood pressure（SBP）,mean arterial pressure（MAP） recovery indexes variation and cure rate,MODS,ARDS complications and transfusion amount.Results：The input of the Study Group for（1266 liquid 257） mL,in the Control Group,CNC control inputs for（liquid were 436） mL,plus or minus two groups of comparisons difference was statistically significant（P0.05）.2 groups of recovery blood lactic acid or alkali before residual value was not statistically significant（P0.05）,recovery after 24 h blood lactic acid or alkali surplus value is statistically significant（P0.05）.In this study MODS 8 cases,ARDS 4 cases,ARF 6 cases.In the two groups,the curative ratio,mortality,and MODS,ARDS incidence were with statistical significance.Conclusion：The restrictive fluid in resuscitating obstetrics and gynecology in treatment in uncontrolled hemorrhagic shock can effectively improve the blood perfusion of tissues and organs of the body,not too much disrupt within environment to improve prognosis,promote early recovery and reduce complications.It has clinical value of application.

关 键 词：妇产科因素 失血性休克 限制性液体复苏 监测 

分 类 号：R441.9[医药卫生—诊断学]