液体复苏在未控制性创伤失血性休克中的应用  

Application of fluid resuscitation in uncontrolled traumatic hemorrhagic shock

作　　者：彭吾训[1] 吴建华[1] 龚翔[1] 

机构地区：[1]贵阳医学院附属医院急诊创伤外科,贵阳550004

出　　处：《中华急诊医学杂志》2012年第8期895-897,共3页Chinese Journal of Emergency Medicine

基　　金：2012年贵州省省长基金西医临床重点应用课题（黔科合SY字〈2012〉3125号）

摘　　要：目的探讨不同液体复苏方式对未控制性创伤失血性休克的治疗效果。方法回顾性分析2006年9月至2010年10月贵阳医学院附属医院急诊创伤外科收治的未控制性创伤失血性休克患者220例，按常规液体复苏（常规组）和限制性液体复苏（限制组）两种复苏方式分组。常规组使收缩压维持在（90～135）mm Hg，限制组使收缩压维持在（70～90）rflnlHg（1mm Hg=0．133kPa）。对两组患者的体温、中心静脉压、输血量、尿量、肾功能、血色素、静脉血渗透压（Osm）、MODS和DIC发生率、诊治费用、病死率进行统计学分析，比较限制性液体复苏与常规液体复苏对失血性休克患者的疗效。结果采用两种不同复苏方式治疗后，两组患者的体温、中心静脉压、输血量、尿量、肾功能、血色素、Osm、MODS和DIC发生率、诊治费用、病死率比较，限制组优于常规组，差异具有统计学意义（P〈0．05）；而两组肾功能障碍发生率比较，差异无统计学意义（P〉0．05）。结论在出血未控制的情况下，限制性液体复苏可维持重要脏器的血流灌注、降低出血量、降低MODS发生率和病死率。Objective To investigate the effects of different ways of fluid resuscitation on uncontrolled traumatic hemorrhagic shock. Methods The retrospective analysis of data from 220 casualties with uncontrolled hemorrhagic shock admitted from September 2006 to October 2010 was carried out. There were two ways of fluid resuscitation used to treat casualties with hemorrhagic shock, conventional fluid resuscitation （group A） and limited fluid resuscitation （group B）. The systolic pressure was maintained at 90-135 mm Hg in the group A and at 70 ~90 mm Hg in the group B. The data of body temperature, central venous pressure, quantity of blood transfused, urine output, renal function, hemoglobin, blood osmotic pressure （Osm） , MODS and DIC rates, treatment costs and mortality of two groups were statistically analyzed and compared. Results After analyses of above mentioned variables except renal function and comparison made between two groups, the method of limited fluid resuscitation was much superior over conventional fluid resuscitation （ P 〈 0. 05 ）. There was no noticeable difference in rate of compromised renal function between two groups （ P 〉 0. 05 ）. Conclusions In the case of uncontrolled exsanguination, the method of limited fluid resuscitation can maintain blood perfusion of vital organs, reduce the blood loss and decrease the incidence of MODS and mortality.

关 键 词：失血性休克 创伤 液体复苏 

分 类 号：R459.7[医药卫生—急诊医学]