术前限制性液体复苏在骨盆骨折合并失血性休克患者中的应用及对预后的影响  

Effect of preoperative limited fluid resuscitation on patients with pelvic fracture complicated with hemorrhagic shock and its impact on the prognosis

作　　者：张春花[1] 孟翠巧[2] 李尚璞 秦延军[1] 国春花[1] 刘雅建 马庆红 张秀果[1] ZHANG Chunhua;MENG Cuiqiao;LI Shangpu(Department of Emergency,the Third Hospital of Hebei Medical University,Hebei,Shijiazhuang 050051,China;不详)

机构地区：[1]河北医科大学第三医院急诊科,石家庄市050051 [2]河北省人民医院 [3]张家口医学院

出　　处：《河北医药》2023年第22期3474-3476,共3页Hebei Medical Journal

基　　金：河北省医学科学研究重点课题计划(编号:20211744)。

摘　　要：目的研究术前限制性液体复苏干预骨盆骨折合并失血性休克患者的临床效果及对预后的影响。方法依照入院顺序,按照随机数字表法将符合标准的失血性休克患者68例分为常规组和限制性液体复苏组,每组34例。比较2组生命体征、凝血功能[血小板(PLT)、凝血酶原时间(PT)、部分凝血活酶时间(APTT)]和代谢功能[血乳酸(Lac)、碱剩余(Be)],分析对患者预后的影响。结果与限制性液体复苏组比较,治疗后常规组患者心率较低,血压、血氧饱和度较高(P<0.05);治疗后与常规组比较,限制性液体复苏组PLT水平较高,APTT时间较长、PT指标水平较低,BE水平较高,Lac水平较低差异均有统计学意义(P<0.05);常规组患者酸中毒、急性呼吸窘迫综合征(MODS)、多器官功能障碍综合征(ARDS)以及创伤性凝血病发生率均高于限制性液体复苏组,差异均有统计学意义(P<0.05)。结论术前给予骨盆骨折合并失血性休克患者限制性液体复苏干预,能够改善患者生命体征、凝血及氧代谢功能,降低患者MODS、ARDS并发症发生率以及死亡率,有着较好的临床应用价值。Objective To explore the clinical outcome of patients with pelvic fracture complicated with hemorrhagic shock who were given preoperative limited fluid resuscitation intervention,and its influence on the prognosis.Methods According to the order of admission,totally 68 patients with hemorrhagic shock randomly were divided into routine group and limited fluid resuscitation group,with 34 cases in each group.The vital signs,coagulation function,including the platelet count(PLT),prothrombin time(PT)and activated partial thromboplastin time(APTT),and metabolic function,including the lactose(Lac)and base excess(Be)of the two groups were compared,and the influence on the prognosis of the patients was analyzed.Results After treatment,patients in the limited fluid resuscitation group presented significantly lower heart rate and significantly higher blood pressure and oxygen saturation than those of routine group(P<0.05).After treatment,patients in the limited fluid resuscitation group presented significantly higher PLT and BE,longer APTT,shorter PT and lower Lac than those of routine group(P<0.05).After treatment,the incidence of acidosis,multiple organ dysfunction syndrome(MODS),acute respiratory distress syndrome(ARDS)and traumatic coagulation disease in the routine group were significantly higher than that of the limited fluid resuscitation group(P<0.05).Conclusion Preoperative limited fluid resuscitation for patients with pelvic fracture complicated with hemorrhagic shock can improve the vital signs,coagulation and oxygen metabolism,and reduce the incidence of MODS and ARDS and the mortality,showing a good clinical value.

关 键 词：骨盆骨折 失血性休克 限制性体液复苏 凝血功能 

分 类 号：R683.3[医药卫生—骨科学]