限制性液体复苏与充分液体复苏治疗创伤失血性休克疗效比较  

Comparison of the effect between limited fluid resuscitation and full fluid resuscitation in the treatment of traumatic hemorrhagic shock

作　　者：吴泽华 WU Ze-hua(Department of Critical Care Medicine,the 105 th Hospital of PLA,Hefei 230031,Anhui Province,China)

机构地区：[1]解放军第105医院重症医学科,安徽合肥230031

出　　处：《新乡医学院学报》2018年第7期573-576,共4页Journal of Xinxiang Medical University

摘　　要：目的比较限制性液体复苏与充分液体复苏治疗创伤失血性休克的临床效果。方法选择2012年1月至2015年1月解放军第105医院收治的创伤失血性休克患者116例,根据液体复苏方法分为观察组和对照组,每组58例。记录2组患者术前输液总量,分别于液体复苏治疗前及液体复苏2 h后检测2组患者氧输送(DO_2)、氧消耗(VO_2)及混合静脉血氧饱和度(SvO_2),凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及碱剩余(BE),血乳酸(BLA)、血小板(PLT)及血红蛋白(Hb)水平;观察2组患者住院期间急性呼吸窘迫综合征(ARDS)、多器官功能障碍综合征(MODS)发生情况及死亡情况。结果观察组和对照组患者术前输液总量分别为(896.1±111.1)、(1 522.2±382.4)m L,观察组患者术前输液总量显著少于对照组(t=11.974,P<0.05)。液体复苏前2组患者PT、APTT及BE、PLT、Hb、BLA水平比较差异均无统计学意义(P>0.05)。与液体复苏前比较,2组患者液体复苏2 h后PT、APTT显著缩短,BLA水平显著降低,PLT、Hb、BE水平显著升高(P<0.05)。液体复苏2 h后,观察组患者PT、APTT显著短于对照组,BLA水平显著低于对照组,PLT、Hb、BE水平显著高于对照组(P<0.05)。液体复苏前2组患者DO_2、VO_2及SvO_2比较差异均无统计学意义(P>0.05),2组患者液体复苏2 h后DO_2、VO_2、SvO_2显著高于液体复苏前(P<0.05);液体复苏2 h后,观察组患者DO_2、VO_2、SvO_2显著高于对照组(P<0.05)。观察组患者ARDS、MODS发生率及病死率分别为15.52%(9/58)、10.34%(6/58)、17.24%(10/58),对照组患者ARDS、MODS发生率及病死率分别为31.03%(18/58)、24.14%(14/58)、34.48%(20/58);观察组患者ARDS、MODS发生率及病死率显著低于对照组(χ2=3.867、4.496、3.910,P<0.05)。结论限制性液体复苏能够有效改善创伤失血性休克患者的凝血功能及氧代谢,降低患者ARDS、MODS发生率及病死率。Objective To compare the effect between limited fluid resuscitation and full fluid resuscitation in the treatment of traumatic hemorrhagic shock.Methods A total of 116 patients with traumatic hemorrhagic shock were selected from January 2012 to January 2015 in the 105 th Hospital of PLA as the research subjects.The patients were divided into observation group and control group according to fluid resuscitation method,with 58 cases in each group.The total amount of preoperative infusion of patients in the two groups was recorded.The oxygen delivery(DO 2),oxygen consumption(VO 2),mixed venous oxygen saturation(SvO 2),prothrombin time(PT),activated partial thromboplastin time(APTT)and the levels of base excess(BE),blood lactic acid(BLA),platelet(PLT)and hemoglobin(Hb)were detected in the two groups before fluid resuscitation and after two hours of fluid resuscitation.The incidence of acute respiratory distress syndrome(ARDS),multiple organ dysfunction syndrome(MODS)and death of patients in the two groups were observed during hospitalization.Results The total amount of preoperative infusion in the observation group and the control group was(896.1±111.1)mL and(1 522.2±382.4)mL respectively,the total amount of preoperative infusion in the observation group was significantly less than that in the control group(t=11.974,P<0.05).There was no significant difference in the levels of PT,APTT,BE,PLT,Hb and BLA between the two groups before fluid resuscitation(P>0.05).Compared with those before fluid resuscitation,the PT and APTT shortened significantly,and the BLA level reduced significantly,and the PLT,Hb and BE levels increased significantly after two hours of fluid resuscitation in the two groups(P<0.05).After two hours of fluid resuscitation,the PT and APTT in the observation group were significantly shorter than those in the control group,the level of BLA in the observation group was significantly lower than that in the control group,and the levels of PLT,Hb and BE in the observation group were significantly higher than

关 键 词：创伤失血性休克 限制性液体复苏 充分液体复苏 氧代谢 

分 类 号：R605.971[医药卫生—急诊医学]