限制性液体复苏对失血性休克复苏患者血浆TNF-α、IL-2的影响  

Effect of restrictive liquid recovery in patients with uncontrolled hemorrhagic shock resuscitation plasma TNF-α,IL-2

作　　者：孙晓光[1] 高洪波 王斌[1] 王会涛[1] 刘彦兵[1] 王建中[1] 

机构地区：[1]河北省唐县人民医院外科,河北唐县067203 [2]中国核工业北京四O一医院肿瘤科,北京102413

出　　处：《大连医科大学学报》2014年第1期31-34,共4页Journal of Dalian Medical University

基　　金：河北省卫生厅2011年医学科学研究重点课题(20110607)

摘　　要：目的探讨使用不同复苏液对失血性休克复苏患者血浆TNF-α、IL-2的影响,以期为失血性休克患者采用液体复苏的方式提供依据。方法选择2010年4月—2012年8月失血性休克患者40例为研究对象,随机分为观察组和对照组各20例,观察组在出血未控制前行限制性液体复苏,对照组在出血未控制前行常规液体复苏,观察两组患者血浆TNF-α、IL-2水平的变化以及复苏期间的液体入量。结果观察组患者日平均复苏液体输入量为(1 946±349)mL,明显低于对照组的(3 522±540)mL,差异具有显著性意义(P<0.05);两组患者的血浆TNF-α水平在复苏后60 min均高于复苏前的水平,差异具有显著性意义(P<0.05),观察组患者的血浆TNF-α水平在复苏后60 min的水平均低于对照组,差异具有显著性意义(P<0.05);两组患者的血浆IL-2水平均在复苏后60 min高于正常值和复苏前的水平,差异具有显著性意义(P<0.05),观察组患者的血浆IL-2水平在复苏后60 min的水平均低于对照组,差异具有显著性意义(P<0.05)。结论限制性液体复苏可显著降低失血性休克患者的出血量,稳定血流动力学,保证心、脑、肾等重要脏器的血流灌注,减轻血液的过度稀释与酸中毒,降低血浆的TNF-α和IL-2水平,改善预后。Objective To study the use of different recovery fluid in patients with uncontrolled hemorrhagic shock resusci -tation fluid plasma TNF-α, the influence of IL-2, so as to provide basis for uncontrolled hemorrhagic shock were treated by liquid recovery way .Methods Forty patients with uncontrolled hemorrhagic shock were selected between April 2010 to August 2010 , they were randomly divided into observation group and control group , observation group using restrictive liquidrecovery,and control group using conventional liquid recovery before bleeding control , serum TNF-α, IL-2 levels of change and recovery liquid intake during recovery in two groups were observed .Results The average recovery liquid of patients in observation group was （1 946 ±349） mL input variables significantly lower than control group ,（3 522 ±540） mL, with statistical difference （P〈0.05）.Two groups patients serum TNF -αlevel 60 min after the recovery are higher than before the recovery level , with statistical difference （P〈0.05）, the observation group of patients with serum TNF -αlevel 60 min after recovery level were significantly lower than the control group , with statistical difference （P〈0.05）.The patient＇s level of serum IL-2 of two group were higher than normal amount of 60 min after the recovery and the level before recovery, with statistical difference （P〈0.05）, the observation group of patients with serum level of IL -2in the 60 min after recovery levels were significantly lower than the control group , with statistical difference （P〈0.05）.Conclu-sion limited fluid resuscitation can significantly reduce uncontrolled hemorrhagic shock in patients with blood loss , stable flow mechanics, guarantee the important organs such as heart , brain, kidney blood perfusion , reduce the excessive blood dilution and acidosis, reduce serum TNF-αand IL -2 levels, improve the prognosis.

关 键 词：限制性液体 复苏 失血性休克 TNF-Α IL-2 

分 类 号：R605.971[医药卫生—急诊医学]