限制性复苏中应用碳酸氢钠林格液和乳酸钠林格液对多发伤并创伤性休克患者Lac、APTT、动脉血pH值的影响  

Effect of limited resuscitation with sodium bicarbonated Ringer's solution and lactated Ringer's solution on Lac,APTT,and arterial blood pH of patients with multiple injuries and traumatic shock

作　　者：周敏 王海波 张强 王笑然 丁文森 张伟 ZHOU Min;WANG Haibo;ZHANG Qiang;WANG Xiaoran;DING Wensen;ZHANG Wei(Department of Critical care Medicine Hai´an people´s Hospital,Hai´an Jiangsu 226600,China)

机构地区：[1]海安市人民医院重症医学科,江苏海安226600

出　　处：《中国急救复苏与灾害医学杂志》2023年第5期651-655,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：江苏省卫生健康委科研项目(编号:Z2019033)。

摘　　要：目的 研究限制性复苏中应用碳酸氢钠林格液和乳酸钠林格液对多发伤并创伤性休克患者乳酸(Lac)、部分凝血活酶时间(APTT)及动脉血酸碱度(PH)的影响。方法 将海安市人民医院2019年1月—2022年1月收治的86例多发伤并创伤性休克患者随机分为观察组(n=46)与对照组(n=40),两组均行限制性复苏治疗,其中观察组限制性复苏中应用碳酸氢钠林格液,对照组应用乳酸钠林格液。比较两组复苏前(T0)及复苏1 h后(T1)血清炎症因子[白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子α(TNF-α)、干扰素γ(IFN-γ)]、血气分析指标[动脉血Lac、氧分压(PaO_(2))、血氧饱和度(SaO_(2))、动脉血pH值]及凝血功能[APTT、血浆纤维蛋白原(FIB),凝血酶原时间(PT)]水平,统计两组多器官功能障碍综合征(MODS)、急性呼吸窘迫综合征(ARDS)及院内死亡率。结果 两组T1时血清IL-6、IL-10及IFN-γ水平均较同组T0时升高,差异具有统计学意义(P<0.05),对照组T1时血清TNF-α水平较T0时升高(P<0.05),观察组两时间点血清TNF-α水平无明显改变(P>0.05)。观察组T1时刻血清IL-6、IL-10、TNF-α水平均低于对照组,差异具有统计学意义(P<0.05),两组T1时刻IFN-γ水平比较,差异无统计学意义(P>0.05)。两组T1时段Lac水平均较同组T0时刻降低,PaO_(2)及动脉血PH值均较同组T0时上升,差异具有统计学意义(P<0.05),且观察组T1时段Lac水平低于对照组,动脉血PH值高于对照组,差异均具有统计学意义(P<0.05)。两组T1时段FIB水平均较其T0时段降低,差异具有统计学意义(P<0.05),两组T1时段ATPP及PT水平与同组T0时段比较,差异均无统计学意义(P>0.05),观察组T1时刻FIB水平高于对照组,差异具有统计学意义(P<0.05)。观察组MODS发生率低于对照组,差异具有统计学意义(P<0.05),两组ARDS及院内死亡率比较,差异无统计学意义(P>0.05)。结论 在多发性创伤失血性休克患者受伤6 h内,相比于�Objective To analyze the effect of limited resuscitation with sodium bicarbonated Ringer´s solution and lactated ringer´s solution on lactic acid(Lac),activated partial thromboplastin time(APTT),and arterial blood pH of patients with multiple injuries and traumatic shock.Methods Eighty patients with multiple injuries and traumatic shock in Hai´an people´s Hospital from January 2019 to January 2022 were randomly classified into two groups,and all patients received limited resuscitation.Observation group(n=46)received sodium bicarbonated Ringer´s solution,while control group(n=40)received lactated Ringer´s solution.Then various parameters were compared between two groups at the baseline and(T0)and 1 hour after resuscitation(T1),including serum inflammatory factors[interleukin-6(IL-6),interleukin-10(IL-10),tumor necrosis factor-α(TNF-α),interferonγ(IFN-γ)],blood gas analysis indexes[arterial blood lactic acid(LAC),partial pressure of oxygen(PaO_(2)),saturation of arterial blood oxygen(SaO_(2)),arterial blood pH]and coagulation function parameters[activated partial thromboplastin time(APTT),plasma fibrinogen(FIB),prothrombin time(PT)].Meantime,the multiple organ dysfunction syndrome(MODS),acute respiratory distress syndrome(ARDS)and in-hospital mortality rate were also recorded.Results Compared with data at T0,serum IL-6,IL-10 and IFN-γlevels were elevated in both groups at T1,with statistical difference(P<0.05).At T1,serum TNF-αlevels were increased in control group(P<0.05),while had no significant change in in observation group(P>0.05).Serum levels of IL-6,IL-10 and TNF-αin observation group at T1 were lower than those in control group(P<0.05),while no significant difference was found in IFN-γlevels between two groups at T1(P>0.05).Compared with data at T0,a decrease in Lac along with an increase in PaO_(2) and arterial blood pH were observed in both groups at T1(P<0.05).Observation group had lower Lac level and higher arterial blood pH than those of control group at T1(P<0.05).FIB value was decreased

关 键 词：限制性复苏 碳酸氢钠林格液 乳酸钠林格液 多发伤 休克 炎症因子 凝血功能 乳酸代谢 

分 类 号：R641[医药卫生—外科学]