创伤失血性休克早期不同液体复苏方案疗效的比较  

Early Fluid Resuscitation Strategy in Patients with Traumatic Hemorrhagic Shock

作　　者：凌进华[1] 张牧城[2] 

机构地区：[1]安徽省黄山市人民医院急诊科,245000 [2]安徽省黄山市人民医院ICU,245000

出　　处：《中华全科医学》2012年第10期1631-1632,共2页Chinese Journal of General Practice

摘　　要：目的探讨创伤失血性休克患者早期液体复苏的策略。方法对2009年6月-2011年2月从入急诊科抢救室抢救到转专科病房或进手术室采取全面彻底控制出血措施为限的132例患者,随机分为平均动脉压(MAP)复苏目标为50～70 mm Hg是治疗组,MAP复苏目标为70～90 mm Hg(1 mm Hg=0.133 kPa)是对照组,比较两组病死率和存活病例并发症发生率。结果早期血压限制液体复苏的治疗组病死率低于早期血压非限制液体复苏的对照组(P<0.05)。存活病例并发症发生率治疗组亦低于对照组(P<0.05),其中注重比较了急性肾功能衰竭(ARF)、多器官衰竭(MODS)两种并发症,两组ARF发生率差异无统计学意义(P>0.05),两组比较MODS发生率治疗组明显低于对照组,差异有统计学意义(P<0.05)。结论创伤失血性休克患者早期血压限制液体复苏能改善患者的预后、减少并发症的发生。Objective To explore the early fluid resuscitation strategy in patients with traumatic hemorrhagic shock. Methods Selecting 132 cases who were admitted into the emergency department, and after being rescued, these patients were transferred to the special wards or operating room for thorough measures to control their bleeding from June 2009 to February 2011. Then these cases were randomly divided into treatment group and control group, with the recovery goal of mean arterial pressure （MAP） targetting 50 -70 mm Hg in treatment group, and 70 -90 mm Hg in control group. Besides, the mortality and survival rate of patients were compared. Results The mortality rate in treatment group with early limit on blood pressure combined with fluid resuscitation was lower than that of the control group（P 〈 0.05） ,and the complication rate of the survival patients was also lower than that of the control group（ P 〈 0.05 ）. Furthermore, two kinds of complications, acute renal failure （ ARF）, multi-organ failure（MODS） were compared. There was no significant difference（ P 〉 0.05 ） between the two groups, and the incidence of MODS in treatment group was significantly lower than that in the control group （ P 〈 0.05 ）. Conclusion The early limit on blood pressure combined with fluid resuscitation in traumatic hemorrhagic shock patients could improve their recovery and reduce the incidence of complications.

关 键 词：创伤失血性休克 早期血压限制 病死率 并发症发生率 

分 类 号：R605.97[医药卫生—急诊医学] R64[医药卫生—外科学]