限制性液体复苏救治重症胸部损伤并创伤失血性休克临床效果  

Clinical Effect of Restrictive Fluid Resuscitation in the Treatment of Severe Thoracic Injury Complicated with Traumatic Hemorrhagic Shock

作　　者：王雄明[1] 罗强[2] WANG Xiong-ming;LUO Qiang(Department of Emergency,Guangxi Zhuang Autonomous Region Ethnic Hospital,Nanning 530001,China;Department of Thoracic and Glandular Surgery,Guangxi Zhuang Autonomous Region Ethnic Hospital,Nanning,530001,China)

机构地区：[1]广西壮族自治区民族医院急诊科,南宁530001 [2]广西壮族自治区民族医院胸心腺体外科,南宁530001

出　　处：《临床误诊误治》2022年第8期78-81,共4页Clinical Misdiagnosis & Mistherapy

基　　金：广西壮族自治区卫生健康委员会基金项目(Z20200615)。

摘　　要：目的 探讨限制性液体复苏救治重症胸部损伤并创伤失血性休克的临床效果。方法 选取2020年3月—2022年2月收治的重症胸部损伤并创伤失血性休克111例,根据治疗方法不同分为研究组(采用限制性液体复苏治疗)54例和对照组(采用常规液体复苏治疗)57例。比较2组复苏期间存活及并发症发生情况,复苏前后氧代谢指标[混合静脉血氧饱和度(SvO_(2))、氧消耗(VO_(2))和氧输送(DO_(2))]、凝血指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)和血细胞比容(HCT)]和临床指标[一氧化氮(NO)、剩余碱(BE)和血清乳酸(BLA)]。结果 复苏期间,研究组存活率高于对照组,并发症总发生率低于对照组(P<0.05)。复苏前,2组氧代谢指标、凝血指标和临床指标比较差异均无统计学意义(P>0.05)。复苏后,2组SvO_(2)、VO_(2)、DO_(2)、HCT均较复苏前升高,APTT、PT、NO、BE和BLA均较复苏前降低;研究组SvO_(2)、VO_(2)、DO_(2)、HCT和BE高于对照组,APTT、PT、NO和BLA低于对照组(P<0.05)。结论 限制性液体复苏救治重症胸部损伤并创伤失血性休克患者有利于提高存活率,减少并发症发生,并可调节氧代谢,改善凝血功能,维持重要脏器血流灌注。Objective To investigate the clinical effect of restrictive fluid resuscitation in the treatment of severe thoracic injury complicated with traumatic hemorrhagic shock(THS).Methods The clinical data of 111 patients with severe thoracic injury and THS admitted to the hospital from March 2020 to February 2022 were retrospectively analyzed.According to different treatment methods,patients were divided into the research group(treated with restrictive fluid resuscitation.n=54)and the control group(treated with conventional fluid resuscitation,n=57).Comparison was made between the groups in terms of survival rate,the incidence of complications,oxygen metabolism indicators[mixed venous oxygen saturation(SvO_(2)),oxygen consumption(VO_(2))and oxygen delivery(DO_(2))],blood coagulation indicators[activated partial thromboplastin time(APTT),prothrombin time(PT)and hematocrit(HCT)],and clinical indicators[nitric oxide(NO),base excess(BE)and serum lactic acid(BLA)].Results During resuscitation,the survival rate of the research group was higher than that of the control group,and the total incidence of complications was lower than that of the control group(P<0.05).There were no significant differences in oxygen metabolism indicators,coagulation indicators and clinical indicators between the groups before resuscitation(P>0.05).After resuscitation,SvO_(2),VO_(2),DO_(2) and HCT in both groups were higher than those before resuscitation,while APTT,PT,NO,BE and BLA were lower than those before resuscitation.SvO_(2),VO_(2),DO_(2),HCT and BE in the research group were higher than those in the control group,while APTT,PT,NO and BLA were lower/shorter than those in the control group(P<0.05).Conclusion Applying restrictive fluid resuscitation to treat patients with severe thoracic injury and THS can improve the survival rate,reduce complications,regulate oxygen metabolism,improve coagulation function,and maintain blood perfusion of vital organs.

关 键 词：胸部损伤 休克 创伤性 限制性液体复苏 存活率 混合静脉血氧饱和度 活化部分凝血活酶时间 一氧化氮 

分 类 号：R655[医药卫生—外科学] R605.971[医药卫生—临床医学]