骨髓腔穿刺技术用于创伤性失血休克患者输液通路建立对抢救成功率的影响  

Effect of bone marrow cavity puncture technique on the success rate of rescue in establishing infusion pathways for patients with traumatic hemorrhagic shock

作　　者：杨玮琦 徐海婷 黄艳萍 虞大为 YANG Wei-qi;XU Hai-ting;HUANG Yan-ping;YU Da-wei(Department of Emergency,the 904th Hospital of the Joint Logistics Support Force of the People′s Liberation Army,Jiangsu Province,Wuxi 214000,China)

机构地区：[1]中国人民解放军联勤保障部队第九〇四医院急诊科,江苏无锡214000

出　　处：《河北医科大学学报》2024年第2期221-225,共5页Journal of Hebei Medical University

基　　金：江苏省自然科学基金项目(BK20201139)。

摘　　要：目的探讨骨髓腔穿刺技术用于创伤性失血休克患者输液通路建立对抢救成功率的影响。方法选取2021年1月—2022年1月40例创伤性失血休克患者,均接受经骨髓腔穿刺建立血管通路,另选骨髓腔穿刺技术开展前(2020年1月—2020年12月)40例创伤性失血休克患者,均接受中心静脉穿刺建立输液通路治疗。观察2组4 h内治疗效果、一次性穿刺成功率、建立输液通路时间、血压回升时间、救治生存率,比较血管通路建立2 h后凝血指标[凝血酶原时间(prothrombin time,PT)、活化部分酶凝血酶时间(activated partial enzyme thrombin time,APTT)、凝血酶时间(thrombin time,TT)]及血气指标[动脉血氧分压(arterial partial pressure of oxygen,PaO_(2))、动脉血二氧化碳分压(partial pressure of arterial blood carbon dioxide,PaCO_(2))、乳酸],观察比较2组不良反应发生率。结果2组性别、年龄、创伤原因比较,差异无统计学意义(P>0.05);观察组有效率显著高于对照组(P<0.05);观察组一次性穿刺成功率、救治生存率占比显著高于对照组,建立输液通路时间、血压回升时间显著低于对照组(P<0.05);治疗后观察组APTT、PT、TT时间显著低于治疗前且低于对照组治疗后(P<0.05);治疗后观察组乳酸、PaCO_(2)水平低于治疗前且低于对照组治疗后,PaO_(2)高于治疗前且高于对照组(P<0.05);观察组不良反应发生率显著低与对照组(P<0.05)。结论利用骨髓腔穿刺技术为创伤性失血休克患者建立血管通路,可提高抢救成功率,且快速有效。Objective To explore the effect of bone marrow cavity puncture technique on the success rate of rescue in establishing infusion pathways for patients with traumatic hemorrhagic shock(THS).Methods A total of 40 patients with THS were selected from January 2021 to January 2022,all of whom underwent bone marrow cavity puncture to establish vascular access,and 40 patients with THS were selected before the development of bone marrow cavity puncture technology(January 2020 to December 2020),all of whom underwent central vein puncture to establish infusion access.The therapeutic effect within 4 h,success rate of one-time puncture,time to establish infusion pathway,time of blood pressure rising and survival rate of treatment were observed in two groups.The coagulation indexes[prothrombin time(PT),activated partial enzyme thrombin time(APTT),thrombin time(TT)]and blood gas indicators[arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),lactic acid],and the incidence of adverse reactions between two groups were observed and compared.Results There was no significant difference in sex,age and cause of trauma between the two groups(P>0.05).The effective rate of the observation group was significantly higher than that of the control group(P<0.05).The success rate of one-time puncture and the survival rate of treatment in the observation group were significantly higher than those in the control group,while the time to establish infusion pathway and blood pressure rising were significantly lower than those in the control group(P<0.05).After treatment,the time of APTT,PT and TT in the observation group was significantly shorter than that before treatment,which were sohorter than that after treatment in the control group(P<0.05).After treatment,the levels of lactic acid and PaCO_(2)in the observation group were lower than those before treatment,which were lower than those in the control group,while PaO_(2)was higher than that before treatment and higher than that in the control group(P

关 键 词：休克 出血性 骨髓 穿刺术 

分 类 号：R605.971[医药卫生—急诊医学]