胸腔内血容量指数及中心静脉血氧饱和度在创伤性休克早期液体复苏中的应用研究  

Applied research on the early fluid resuscitation in patients with traumatic shock by monitoring ITBVI and ScvO_2

作　　者：宋志[1] 赵秀[2] 侯明晓[1] 高燕[1] 

机构地区：[1]解放军沈阳军区总医院急诊科,全军重症战创伤救治中心,沈阳110016 [2]沈阳医学院口腔医学教研室

出　　处：《临床急诊杂志》2013年第11期510-513,共4页Journal of Clinical Emergency

基　　金：全军"十二五"后勤科研项目(No:CSY12J002)

摘　　要：目的:探讨胸腔内血容量指数(ITBVI)及中心静脉血氧饱和度(ScvO2)在指导创伤性休克患者早期液体复苏的意义,为创伤性休克的早期临床诊治决策提供依据。方法:为前瞻性观察研究,对已诊断创伤性休克的患者进行早期目标导向治疗(EGDT)。对不符合传统休克诊断标准的患者进行随机分为实验组和对照组。记录血液生化指标及各组患者机械通气时间数、ICU住院时间数及7d、28d的病死率,感染相关性器官功能衰竭评分(SOFA评分)。采用统计学软件SPSS17.0进行数据处理及分析。结果:与对照组比较,实验组患者治疗48h后肌酐下降更为明显;治疗后24h实验组较对照组SOFA评分明显降低(P<0.05);实验组ICU住院时间、机械通气时间对照组有所降低,但差异无统计学意义;28d病死率实验组较对照组明显著降低(P<0.05)。结论:通过监测ITBVI及ScvO2能早期发现创伤性休克时机体容量及组织灌注不足状态,从而早期进行液体复苏,降低创伤性休克患者病死率。Objective：To investigate the application of ITBVI and ScvO2 in early fluid resuscitation of traumatic shock,and to provide basis for the early clinical diagnosis and treatment of traumatic shock.Method：To perform prospective observational study,early goal-directed therapy（EGDT）was applied in patients diagnosed with trau- matic shock.Patients who could not meet the diagnostic criteria of traditional shock were randomly divided into ex- perimental and control groups.Data including blood biochemical parameters,the number of patients mechanical ventilation,ICU length of stay and the number of 7 days to 28 days mortality and infection-related organ failure as- sessment（SOFA score）were recorded.SPSS software of version 17.0 was used to process and analysis data.Result：Compared with the control group,serum creatinine after 48 hours in test group decreased more obviously.The SOFA score of experiment group was lower than that of control group（P0.05）.The length of staying in the ICU and the time of mechanical ventilation reduced,but the difference was not statistically significant.The mortality of 28 days was significantly reduced than the control group（P0.05）.Conclusion：Inadequacy of early organism volume and organization perfusion in traumatic shock can be found through monitoring ITBVI and ScvO2.Thus, early fluid resuscitation can be performed in order to improve the recovery effect and reduce the mortality patients of traumatic shock.

关 键 词：休克 创伤性 胸腔内血容量指数 中心静脉血氧饱和度 病死率 

分 类 号：R605.971[医药卫生—急诊医学]