碳酸氢钠林格注射液对创伤失血性休克患者的复苏效果研究  

Resuscitation effect of sodium bicarbonate Ringer's solution on traumatic hemorrhagic shock in patients

作　　者：成斌[1] 葛风 丁谦谦[1] Cheng Bin;Ge Feng;Ding Qianqian(Emergency Department of Yiwu Central Hospital,Yiwu 322000,Zhejiang Province,China)

机构地区：[1]义乌市中心医院急诊科,义乌322000

出　　处：《中国基层医药》2024年第3期422-426,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的分析碳酸氢钠林格注射液对创伤失血性休克患者的复苏效果。方法选取义乌市中心医院2021年2月至2022年2月收治的创伤失血性休克患者70例进行随机对照研究,按照随机数字表法将其分为对照组(n=35)和观察组(n=35)。在常规救治基础上,对照组给予充足复方氯化钠注射液复苏治疗,观察组给予限制性碳酸氢钠林格注射液复苏治疗,比较两组临床相关指标、凝血功能和乳酸水平、血液流变学指标、并发症发生情况。结果观察组血氧饱和度、休克指数、血压脉率差、尿量分别为(76.53±2.56)%、(0.43±0.07)、(38.56±6.52)mmHg(1 mmHg=0.133 kPa)、(35.62±4.21)mL/h,均优于对照组的(65.32±3.21)%、(1.21±0.13)、(23.56±4.23)mmHg、(23.65±5.68)mL/h(t=16.15、31.25、11.42、10.06,均P<0.001)。观察组凝血酶原时间、纤维蛋白原、活化部分凝血活酶时间、凝血酶时间分别为(17.65±0.83)s、(1.69±0.89)g/L、(39.68±0.52)s、(17.86±0.74)s,均优于对照组的(14.56±0.86)s、(1.32±0.23)g/L、(35.26±0.16)s、(16.02±0.05)s,乳酸为(2.24±0.53)mmol/L,低于对照组的(2.94±0.78)mmol/L(t=15.30、2.38、48.06、14.68、4.39,均P<0.05)。两组血小板凝聚力、红细胞变形性、血液黏度均显著降低,且观察组均优于对照组(t=13.71、5.64、5.67,均P<0.001)。观察组并发症发生率为8.6%(3/35),低于对照组的60.0%(21/35)(χ^(2)=10.08,P<0.05)。结论碳酸氢钠林格液限制性液体复苏可改善创伤失血性休克患者的临床指标、凝血功能和乳酸水平,有效改善血流动力学指标,减少并发症的发生,值得临床推广。Objective To investigate the resuscitation effect of sodium bicarbonate Ringer's solution on traumatic hemorrhagic shock in patients.Methods A randomized controlled trial was conducted on 70 patients with traumatic hemorrhagic shock who were admitted to Yiwu Central Hospital between February 2021 and February 2022.The patients were randomly assigned to a control group(n=35)and an observation group(n=35)using the random number table method.Both groups received routine treatment.The control group was given adequate resuscitation by intravenous injection of a compound sodium chloride injection,while the observation group received restricted resuscitation with sodium bicarbonate Ringer's solution.Related clinical indicators,coagulation function,lactate levels,hemorheological indicators,and incidence of complications were compared between the two groups.Results The blood oxygen saturation,shock index,pulse pressure difference,and urine output in the observation group were(76.53±2.56)%,(0.43±0.07),(38.56±6.52)mmHg(1 mmHg=0.133 kPa),and(35.62±4.21)mL/h,respectively.These values were all superior to those in the control group[(65.32±3.21)%,(1.21±0.13),(23.56±4.23)mmHg,(23.65±5.68)mL/h,t=16.15,31.25,11.42,10.06,all P<0.001].The prothrombin time,fibrinogen,activated partial thromboplastin time,and thrombin time in the observation group were(17.65±0.83)seconds,(1.69±0.89)g/L,(39.68±0.52)seconds,and(17.86±0.74)seconds,respectively.These values were significantly superior to those in the control group[(14.56±0.86)seconds,(1.32±0.23)g/L,(35.26±0.16)seconds,and(16.02±0.05)seconds,t=15.30,2.38,48.06,14.68,all P<0.05].The lactate level in the observation group was significantly lower than that in the control group[(2.24±0.53)mmol/L vs.(2.94±0.78)mmol/L,t=4.39,P<0.05].The platelet cohesion,red blood cell deformability,and blood viscosity in each group were significantly reduced,and these indices in the observation group were superior to those in the control group(t=13.71,5.64,5.67,all P<0.001).The incidence of co

关 键 词：创伤和损伤 休克 出血性 血液凝固因子 乳酸 血液流变学 碳酸氢钠林格液 

分 类 号：R605.971[医药卫生—急诊医学]