限制性液体复苏与常规液体复苏治疗胸部创伤失血性休克的疗效比较  

Comparison on the controlled fluid resuscitation and the regular fluid resuscitation in hemorrhagic shock caused by chest trauma

作　　者：郑悦亮[1] 蔡文伟[1] 吴志伟[1] 陈旭明[1] 陈杰[1] 

机构地区：[1]浙江省人民医院急诊科,310006

出　　处：《中国急救复苏与灾害医学杂志》2013年第5期417-419,430,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：浙江省卫生厅一般基金项目（2012kyb012）

摘　　要：目的总结胸部创伤失血性休克患者液体复苏治疗策略。方法回顾性分析符合研究标准的68例胸部创伤失血性休克患者液体复苏治疗的相关资料，限制性液体复苏组在彻底止血前，只给予少量的平衡液维持机体基本需求；常规液体复苏组入院后快速给予大量等张晶体液和（或）胶体液。用成组t检验、方差分析或卡方检验分析两种液体复苏方式对血红蛋白含量、血小板计数、红细胞比容、凝血酶原时间、血乳酸含量、碱缺失水平、机械通气率及病死率的影响。结果限制性液体复苏组与常规液体复苏组术后血红蛋白、凝血酶原时间、血小板计数、红细胞比容、血乳酸和碱缺失两组间差异具有统计学意义（P〈0．05）。常规液体复苏组病死率高于限制性液体复苏组病死率，差异有统计学意义（P〈0．05）。机械通气率限制性液体复苏组低于常规液体复苏组，差异有统计学意义（P〈0．05）。结论限制性液体复苏能显著改善胸部创伤失血性休克患者凝血功能、组织和器官的灌注及乳酸酸中毒程度，降低机械通气率，效果优于常规液体复苏。Objective To analyze the two fluid resuscitation strategies in chest trauma patients with hemorrhagic shock. Methods 68 cases of chest trauma with hemorrhagic shock which met the study criteria were retrospectively analyzed. The patients were randomly divided into the controlled fluid resuscitation group （CF group） and the regular fluid resuscitation group （AF group）. CF group was only given a small amount of Ringer for the body＇ s basic needs before completing homeostasis, while AF group was rapidly given a lot of Ringer and/or colloid. Adopting the group t test, analysis of variance or chi-square test, the influence on hemoglobin, platelet count, hematocrit, prothrombin time, blood lactate, base deficit levels, mechanical ventilation rate and mortality caused by two different fluid resuscitation strategies were analyzed. Results The Hemoglobin, prothrombin time, platelet count, hematocrit, blood lactate and base deficit between the two groups reflected a significant difference （P〈0.05）. The AF group demonstrated a higher mortality and a higher mechanical ventilation rate than the CF group, with a significant difference （P〈O.05）. Conclusion Controlled fluid resuscitation strategy is considered being more significantly effective in improving coagulation, tissue and organ perfusion and lactic acidosis in chest trauma with hemorrhagic shock, resulting in a lower mechanical ventilator and mortality rate, comparing with the regular fluid resuscitation strategy.

关 键 词：胸部创伤 创伤性失血性休克 限制性液体复苏 

分 类 号：R605.974[医药卫生—急诊医学]