限制性液体复苏对多发性骨折合并创伤失血性休克患者凝血功能及炎性因子的影响  

Effect of Limited Fluid Resuscitation on Coagulation Function and Inflammatory Factors in Patients with Multiple Fractures combined with Traumatic Hemorrhagic Shock

作　　者：孙锋 刘佳佳[1] 薛建华[1] 盛小明[1] 杨洋[1] SUN Feng;LIU Jiajia;XUE Jianhua;SHENG Xiaoming;YANG Yang(Department of Trauma Center,Affiliated Hospital of Nantong University,Jiangsu 226001)

机构地区：[1]南通大学附属医院创伤中心,江苏226001

出　　处：《交通医学》2023年第6期556-559,共4页Medical Journal of Communications

基　　金：江苏省研究型医院资助基金(YJXYY202204-YSB20);南通市卫生健康委科研课题面上项目(MS2023016);南通大学附属医院教学研究课题(Tjf 22018)。

摘　　要：目的:探讨限制性液体复苏对多发性骨折合并创伤失血性休克(traumatic hemorrhagic shock,THS)患者凝血功能及炎性因子的影响。方法:选取本院创伤中心收治的多发性骨折合并THS患者75例。按接诊时间分为对照组和观察组,其中对照组37例,观察组38例。对照组进行常规液体复苏,观察组进行限制性液体复苏(limited fluid resuscitation,LFR)。比较两组患者复苏前后凝血功能、炎性因子指标,统计治疗过程中急性呼吸窘迫综合征、弥散性血管内凝血、多器官功能障碍综合征及7 d内死亡率。结果:复苏前,两组患者凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)比较无统计学差异(P>0.05);复苏后,两组PT、APTT均较复苏前延长,但观察组指标均短于对照组(P<0.01);两组患者复苏后IL-6、TNF-α水平均高于复苏前,观察组炎症因子水平低于对照组(P<0.01);观察组并发症发生率较对照组低,有统计学意义(P<0.05);两组7 d内死亡率比较无统计学意义(P>0.05)。结论:LFR可以改善多发性骨折合并THS患者凝血功能,减轻炎症反应,减少并发症发生。Objective:To investigate the effect of limited fluid resuscitation on coagulation function and inflammatory factors in patients with multiple fractures combined with traumatic hemorrhagic shock(THS).Methods:75 patients with multiple fractures combined with THS admitted to the Trauma Center of Affiliated Hospital of Nantong University were selected.They were divided into the control group and the observation group according to the receiving time.There were 37 cases in the control group and 38 cases in the observation group.The control group received conventional fluid resuscitation,while the observation group received limited fluid resuscitation.Coagulation function and inflammatory factors were compared between the two groups before and after resuscitation,and acute respiratory distress syndrome,disseminated intravascular coagulation,multiple organ dysfunction syndrome and mortality within 7 days were analyzed during treatment.Results:Before resuscitation,there were no significant differences in the levels of PT,APTT,IL-6 and TNF-αbetween the two groups(P>0.05).After resuscitation,the levels of PT and APTT in the two groups were prolonged compared with those before resuscitation,but the indexes in the observation group were shorter than those in the control group(P<0.01).The levels of IL-6 and TNF-αin the two groups were higher than those before resuscitation,and the indexes in the observation group were lower than those in the control group(P<0.01).The incidence of complications in the observation group was lower than that in the control group,with statistical significance(P<0.05),and there was no significant difference in mortal ity within 7 days between the two groups(P>0.05).Conclusion:LFR can improve coagulation function,reduce inflammation and complications in patients with multiple fractures combined with THS.

关 键 词：限制性液体复苏 多发性骨折合并创伤失血性休克 凝血功能 炎症因子 

分 类 号：R683[医药卫生—骨科学]