院前适度低压复苏对严重创伤出血患者器官功能保护作用观察  

Effects of permissive hypotensive resuscitation during pre-hospital for severe traumatic patients

作　　者：李涛[1] 胡平[2] 胡弋 刘良明[1] LI Tao 1,HU Ping 2,HU Yi 3,LIU Liang-ming 1(1.Second Department of Research Institute of Surgery,Daping Hospital,Army Military Medical University,Chongqing 400042,China; 2 Department of Trauma,Chongqing Emergency Medical Center,Chongqing400014,China; 3.Department of Anesthesiology,Daping Hospital,Army Military Medical University,Chongqing400042,Chin)

机构地区：[1]陆军军医大学大坪医院野战外科研究所第二研究室,重庆400042 [2]重庆市急救医疗中心创伤科,重庆400014 [3]陆军军医大学大坪医院麻醉科,重庆400042

出　　处：《创伤外科杂志》2018年第8期595-599,共5页Journal of Traumatic Surgery

摘　　要：目的观察严重创伤患者院前允许性低压复苏的效果。方法采用前瞻性研究,对在重庆市急救医疗中心和陆军军医大学大坪医院急救部收治的63例严重创伤患者(ISS 16~25),根据随机数字表法分为常压复苏组(MAP 80mm Hg,38例)和低压复苏组(MAP 60mm Hg,25例)。其中男性46例,女性17例;道路交通伤52例,刀刺伤7例,坠落伤4例。观察止血前分别采用常压复苏或低压复苏处理对患者输血输液量、血流动力学、血气、凝血功能以及器官功能的影响。结果与常压复苏组相比,手术止血前低压复苏可降低患者运输和手术过程中的输血、输液量,增加血球压积,稳定血流动力学参数和改善氧饱和度,常压复苏组的输液量、术中输液量和术中输血量分别为1 643、3 526和361m L,低压组分别为543、1 801和201m L(P<0.01);低压组血球压积为32.3%,显著高于常压组(24.1%,P<0.01);同时低压复苏组患者的器官功能(肝、肾)和凝血功能明显优于常压复苏组。结论适度低压复苏可保护严重创伤患者的器官功能,MAP60mm Hg是较理想的目标复苏压力。Objective To investigate the effect of permissive hypotensive resuscitation on severe trauma patients during pre-hospital. Methods A total of 63 severe traumatic patients （ISS：16-25） who received normotensive fluid resuscitation （mean arterial pressure （MAP） 80 mmHg, n =38） or hypotensive fluid resuscitation （MAP 60mmHg, n =25） were prospectively studied. Among them were 46 males and 17 females,with 52 injured from road traffic accidents,7 from stab injury and 4 from high falling. Before bleeding control by operation,the influence of resuscitation on the volumes of fluid and blood,the changes of hemodynamics,blood gas,coagulation function and organ function were observed. Results As compared with normotensive fluid resuscitation during pre-hospital,hypotensive fluid resuscitation （MAP 60mmHg） were beneficial to severe traumatic patients,which could decrease the fluid requirement and blood infusion,increase hemotocrit,stabilize hemodynamics and improve SaO 2. The volume of infusion,intraoperative infusion and blood transfusion in the normotensive fluid resuscitation were 1 643,3 526 and 361mL,respectively,whereas in hypotensive resuscitation group were 543,1 801 and 201mL,respectively （ P 〈 0.01）. The hematocrit was 32.3% in the hypotensive resuscitation group,which was significantly higher than that of the normotensive fluid resuscitation （24.1%, P 〈0.01）. The organ function including liver and kidney,and coagulation function in hypotensive resuscitation patients were better than in normotensive resuscitation group. Conclusion Appropriate hypotensive resuscitation is beneficial for severe trauma patients during pre-hospital,which can protect the organ function of severe trauma patients. MAP at 60mmHg is the proper target resuscitation pressure.

关 键 词：创伤 复苏压力 液体复苏 出血控制 

分 类 号：R681[医药卫生—骨科学]