腹腔复苏治疗失血性休克的研究进展  

Research progress on direct peritoneal resuscitation in the treatment of hemorrhagic shock

作　　者：刘兆兴 李大伟[1] 钮跃增 张文[1] 马景龙 申传安[1] Liu Zhao-Xing;Li Da-Wei;Niu Yue-Zeng;Zhang Wen;Ma Jing-Long;Shen Chuan-An(Department of Burns and Plastic Surgery,the Fourth Medical Center of Chinese PLA General Hospital,Beijing 100048,China)

机构地区：[1]解放军总医院第四医学中心烧伤整形科,北京100048

出　　处：《解放军医学杂志》2020年第12期1304-1308,共5页Medical Journal of Chinese People's Liberation Army

基　　金：军队后勤科研计划重大项目(ALB18J001);“十三五”军队重点学科专业建设项目(A350109)。

摘　　要：失血性休克是指各种原因造成机体大量失血所致有效循环血量减少、组织灌注不足、细胞代谢紊乱和器官功能受损的病理生理过程。液体复苏是失血性休克紧急内科治疗的关键环节。腹腔复苏是指通过腹腔穿刺的方式将所需输注的液体注入腹膜腔内的新型液体复苏方法。腹腔补液穿刺点固定、操作简单,受环境因素影响较小,在静脉输液通道建立困难的情况下,可快速建立补液通路,有效改善血流动力学指标,起到补液抗休克的作用。此外,在静脉补液的同时,辅以腹腔复苏能够改善静脉复苏的效果,在改善微循环、增加脏器血流、减轻组织器官水肿及抑制全身炎症反应等方面具有重要价值。该文就腹腔复苏的优势、液体选择及作用机制进行综述,旨在为失血性休克液体复苏提供新的思路。Hemorrhagic shock refers to the pathophysiological process of reduced effective circulating blood volume,insufficient tissue perfusion,disorder of cell metabolism,and impaired organ function caused by the body's massive blood loss due to various causes.The key to improving the success rate of its treatment is to recover effective tissue perfusion as soon as possible to improve the oxygen supply to tissue cells,rebalance oxygen supply and demand,and restore normal cell functions while eliminating the cause of shock.The key to emergent care of hemorrhagic shock is timely and effective fluid resuscitation,which can directly affect the prognosis of patients.How to effectively provide fluid resuscitation is a clinical challenge that doctors must take into consideration.Direct peritoneal resuscitation represents a new approach by which the required infusion fluid is administered into the peritoneal cavity by means of abdominocentesis and absorbed through the peritoneal blood vessels and lymphatic vessels.This fluid resuscitation technique is characterized by fixed puncture points and easy operations,and it is less affected by environmental factors.Using this technique,the fluid can be infused at once in a short time.When it is difficult to establish an intravenous infusion pathway,a fluid resuscitation pathway can be quickly established,which can effectively improve hemodynamic indicators and achieve fluid resuscitation against shock.In addition,at the same time of intravenous fluid resuscitation,direct peritoneal resuscitation can improve the effect of intravenous resuscitation,which is of great significance in improving micro-circulation,increasing organ blood flow,reducing organ and tissue edema,and inhibiting systemic inflammation.This article attempts to review the merits,fluid selection and mechanism of direct peritoneal resuscitation,aiming to provide new ideas for fluid resuscitation of hemorrhagic shock.

关 键 词：失血性休克 液体复苏 腹腔复苏 

分 类 号：R644[医药卫生—外科学]