3％和7．5％高渗盐水治疗创伤失血性休克的临床研究  

Hypovolemia shock resuscitated with 3 % and 7. 5 % hypertonic saline in emergency department

作　　者：乔着意[1] 韩鹃[1] 王兴志[1] 刘剑[1] 赵庆波[1] 刘万宝[1] 

机构地区：[1]解放军324医院急诊科,重庆400020

出　　处：《中华急诊医学杂志》2014年第5期496-500,共5页Chinese Journal of Emergency Medicine

基　　金：重庆市医学科研计划项目（2011-2-593）

摘　　要：目的探讨单剂质量分数为3％和7.5%的高渗盐水在创伤失血性休克急救早期液体复苏中的应用。方法2008年12月至2012年2月，将年龄＞15岁，收缩压≤70 mmHg或介于70-90 mmHg（1 mmHg=0.133kPa）而心率＞108次/min的严重创伤患者，随机（随机数字法）分为三组进行液体复苏，A组：3％高渗盐水300 mL＋林格式液；B组：7.5％高渗盐水300 mL＋林格液；C组：林格液。观察其输液前及之后10、30、45、60 min时平均动脉压（MAP）、血压、心率、电解质变化，不良反应以及后期MODS、病死率情况。结果148例患者入选本项研究。A、B组的升压效果明显优于C组。B组MAP在用药后30 min达到峰值（76.22±3.12） mmHg，高于A组，但其他时间点与A组差异无统计学意义。1 h所用液体总量A、B组仅为C组的50%。B组心率的变化幅度明显高于其余两组，尤其在10 min时相点，平均达到127次/min，出现严重心慌不适的患者比例高于其他两组，少部分患者还出现一过性的血压下降。而A、C两组间心率变化差异无统计学意义。三组用药前后电解质改变均不明显，三组比较MODS及病死率差异均无统计学意义。结论在创伤性失血性休克患者的救治早期，单剂300mL 3％和7.5％高渗盐水都有助于提高和维持血压。两种质量分数的高渗盐水升压效果近似，3％高渗盐水的耐受性和安全性更好。Objective To investigate the effects of 3% and 7.5% hypertonic saline （HS） on hemorrhagic shock patients in Emergency Department. Methods From December 2008 to February 2012, patients older than 15 years with severe trauma and systolic blood pressure （SBP） ≤70 mmHg or 70 to 90 mmHg with heart rate≥108 per minute were divided into three groups randomly （random number）. Group A： patients treated with 3% hypertonic saline （HS） 300 mL ＋ lactated Ringer＇s solutions （LRS）. Group B： patients treated with 7.5% HS 300 mL ＋ LRS. Group C： patients treated with LRS. The mean arterial pressure （MAP）, blood pressure （BP）, heart rate （HR） were recorded before infusion and at 10, 30, 45, 60 minutes successively after infusion. Incidence of complications and mortality rates were compared between groups. Results Atotal of 148 patients were enrolled in this study. Compared with LRS grouop, MAP was restored more promptly and maintained persistently in 3% HS group and 7.5% HS group, and the total volume of fluid infused was decreased to almost 50% of LRS in the first 1 hour. No significant differences in MAP levels were observed between group A and B except 30 minutes after infusion. Single bolus of 7. 5% HS infusion resulted in increased of HR to mean 127 beats per minute at 10 minutesafter fluid resuscitation. Higher incidence of arrhythmia and transient hypotension occurred in 7.5% HS group. There were no statistical differences of changes of electrolytic indices, mortality rates, incidences of ARDS and MODS among three groups. Conclusions Resuscitation with 3% HS provide similar benefits and lower risk of complications compared with 7.5% HS and LRS. This study demonstrates the practicability and safety of 3% HS for fluid resuscitation of patients with hypovolemic shock .

关 键 词：3%高渗盐水 7.5%高渗盐水 失血性休克 急救 复苏 创伤 血流动力学 

分 类 号：R605.971[医药卫生—急诊医学]