急诊超声在严重创伤失血性休克患者病情评估及救治中的应用  

Application of emergency ultrasound in assessment and treatment of severe traumatic hemorrhagic shock

作　　者：王志华 张乐乐 顾东明 盛乐智 徐主恩 林兆奋[2] Wang zhi hua;Zhang Le ie;Gu Dong ming;SHENG Le zhi;XU Zhu en;LIN Zhao fen(Department of Critical Care Medicine, Pudong Hospital Affiliated to Fudan University, Shanghai 201399, China)

机构地区：[1]上海市浦东医院重症医学科,上海201399 [2]上海市长征医院急救科

出　　处：《中国急救复苏与灾害医学杂志》2019年第4期313-317,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：上海市浦东医院“浦菁计划”人才培养(PJ201501).

摘　　要：目的探讨急诊超声在严重创伤失血性休克患者病情评估及救治中的应用价值。方法随机选取2017年1月-2018年2月复旦大学附属浦东医院重症医学科62例经皮静脉穿刺置管救治的严重创伤失血性休克患者,并随机分为两组,对照组采用常规的液体复苏治疗方法,观察组采用急诊超声评估下液体复苏法,比较两组患者液体复苏情况及穿刺成功率。结果观察组的复苏成功率显著高于对照组(X^2=5.43.P =0.032)。复苏lh后两组患者的心率(heart rate, HR ),平均动脉压(mean arterial pressure, MAP),尿量,酸碱度(power of hydrogen,Ph )PH和碱剩余(buffuer excess, BE),乳酸(lactic acid,Lac)无差异性,在复苏24 h后发现观察组的HR,Lac显著低于对照组.MAP,尿量,BE显著高于对照组(P<0.05).复苏1 h后两组患者的HR,MAP,尿量,PH和BE,Lac无差异性,在复苏24h后发现观察组的HR, Lac显著低于对照组.MAP,尿量.BE显著高于对照组(P <0.05)。在敏感度,特异性方面,相对活力指数(relative vigor index indicators, RVI)高于Dmax, Dmin和中心静脉压(central venous pressure,△CVP).观察组的一次穿刺成功率,总体成功率显著高于对照组,观察组的并发症发生率和操作时间显著小于对照组(P <0.05)。结论急诊超声对严重创伤失血性休克具有较好的评估价值,RVI可作为预测病情指标,值得在临床上推广和应用。Objective To explore the value of emergency ultrasound in the assessment and treatment of severe traumatic hemorrhagic shock. Methods 62 patients with severe traumatic hemorrhagic shock treated wity fluid resuscitation were randomly divided into 2 groups: treated by percutaneous vein catheterization from January 2017 to February 2018 in our hospital were randomly selected and randomly divided into two groups. The control group undergoing conventional internal jugular vein puncture and observation group undergoing ultrasound to observe the respiration variation index (RVI) of the internal diameter of the internal jugular vein as an index of fluid resuscitation. The values of hart rate (HR), mean arterial pressure (MAP), urine volume, pH, blood oxygen saturation (StO:), base excess (BE), lactic acid (Lac), cardiac ejection fraction (EF), cardiac output index (CI), vasoactive drugs application time, and 24h mortality were recorded. 50 ml 6% hydroxyethvl starch was injected 30 min after untrasound diagnosis to observe the capacity reaction. Results The success rate of recovery of the observation group was 90.3%, significantly higher than that in the control group (74.3%, x^2=5.4, P =0.032). Heart rate (HR), mean arterial pressure (MAP), urine volume, power of hydrogen PH and huffuer excess (BE), lactic acid (lac) after 1 h of resuscitation There was no difference in lactic acid. Lac). After 24 hours of resuscitation, the HR of the observation group was significantly lower than that of the control group. The MAP, urine volume and BE were significantly higher than the control group (P <0.05). There was no difference in HR, MAP, urine volume, PH and BE, and Lac between the two groups after 1h of resuscitation. 24 hours after the resuscitation, the fluid infusion volume, B line incidence rate, 24 h mortality, and △ SOFA score were all significantly lower, and the vasoactive drug application time was significantly shorter in the observation group compared to the control group (all P <0.05). In terms of sensitivity and s

关 键 词：急诊超声 创伤 失血性休克 

分 类 号：R541.64[医药卫生—心血管疾病]