不同液体复苏方法治疗严重骨盆骨折失血性休克的效果及预后分析  

Clinic effect and prognosis analysis of different emergency fluid resuscitation methods foRhemorrhagic shock following severe pelvic fractures

作　　者：崔锐红 罗恒 瞿丽娟 尹文 李俊杰 王倩梅 徐云云 王娇 黄杨 Cui Ruihong;Luo Heng;Qu Lijuan;Yin Wen;Li Junjie;Wang Qianmei;Xu Yunyun;Wang Jiao;Huang Yang(Department of Emergency,the First Affiliated Hospital of AiRForce Medical University,Xi’an 710032,China;Department of Surgical Operation Room,the First Affiliated Hospital of AiRForce Medical University,Xi an 710032,China)

机构地区：[1]空军军医大学第一附属医院急诊科,西安710032 [2]空军军医大学第一附属医院外科手术室,西安710032

出　　处：《创伤外科杂志》2024年第8期586-592,共7页Journal of Traumatic Surgery

基　　金：国家重点军事项目(BWS21J002)。

摘　　要：目的探究不同液体复苏方法治疗严重骨盆骨折失血性休克的效果及预后分析。方法前瞻性选取2021年6月—2023年6月笔者医院收治的严重骨盆骨折失血性休克患者96例为研究对象,其中男性56例,女性40例;年龄18~55岁,平均38.6岁;道路交通伤51例,高处坠落伤24例,挤压伤21例。患者入院后均完成止血、骨折外固定等外科急救处理,常规监测生命体征、建立静脉通道、完善血常规等术前检查。随机数字表法分为研究组48例与对照组48例。对照组患者进行常规快速液体复苏,及时补充足量的平衡液、胶体液、悬浮红细胞、血浆等,研究组予以限制性液体复苏,前期适当输入高渗氯化钠溶液,而后输入平衡液等。比较两组入院时、复苏后3 d生命体征指标,凝血指标与急性生理与慢性健康II(APACHEⅡ)评分,电解质水平以及入院时、复苏后30 min、1 h炎症因子水平,观察两组预后指标差异。结果两组复苏后3 d全心舒张末期容量指数(GEDVI)、心脏指数(CI)、心排血量(CO)、氧合指数(PaO_(2)/FiO_(2))、MAP、中心静脉压(CVP)与入院时比较均升高,血乳酸(LAC)、HR与入院时比较均降低(P<0.05);且研究组复苏后3 d上述生命体征指标改变幅度优于对照组(P<0.05)。两组复苏后3 d TT、PT、APTT与入院时比较均升高,APACHEⅡ评分与入院时比较均降低(P<0.05);且研究组复苏后3 d TT、PT、APTT、APACHEⅡ评分均低于对照组(P<0.05)。两组复苏后3 d Na+与入院时比较均升高,K+与入院时比较均降低(P<0.05);但两组复苏后3 d Cl^(-)、Mg^(2+)、Na^(+)、K^(+)比较差异无统计学意义(P>0.05)。重复测量方差分析结果显示,两组y干扰素(y-IFN)、IL-4、IL-6、TNF-α的时点、组间、交互效应比较差异有统计学意义(P<0.05),两组复苏后30 min、1 h的y-IFN、IL-4、IL-6、TNF-α与入院时相比均显著升高,且复苏后1 h的y-IFN、IL-4、IL-6、TNF-α高于复苏后30 min(P<0.05),但研究组Objective To explore the clinical effect and prognosis of different emergency fluid resuscitation methods in the treatment of hemorrhagic shock following severe pelvic fractures.Methods A total of 96 patients with severe pelvic fractures and hemorrhagic shock admitted to ouRhospital from Jun.2021 to Jun.2023 were prospectively selected as the study objects.Among the 96 patients,56 were male and 40 were female,with an average age of 38.6 years.The main cause of injuries was road traffic accidents(51 cases),followed by falls(24 cases)and crushing injuries(21 cases).The patients were divided into study group(48 cases)and control group(48 cases)according to the random numbeRtable method.AfteRadmission,all patients underwent surgical emergency treatment such as hemostasis,external fixation of fractures,routine monitoring of vital signs,establishment of venous channels,and blood routine exam.Patients in the control group were subjected to routine rapid fluid resuscitation,supplemented with sufficient equilibrium fluid,colloidal fluid,suspended red blood cells,plasma,etc.,while those in the study group were subjected to restricted fluid resuscitation,with appropriate input of hypertonic sodium chloride solution in the early stage and then input of equilibrium fluid.The vital sign indexes at 3 d afteRresuscitation,coagulation indexes,acute physiological and chronic healthⅡ(APACHEⅡ)scores,electrolyte levels,and inflammatory factors levels at admission,30 min and 1 h afteRresuscitation were compared between the two groups.The differences in prognostic indexes were also observed.Results The whole heart end diastolic volume index(GEDVI),cardiac index(CI),cardiac output volume(CO),oxygenation index(PaO_(2)/FiO_(2)),mean arterial pressure(MAP)and central venous pressure(CVP)at 3 d afteRresuscitation increased while blood lactate(LAC)and heart rate(HR)decreased,all revealing significant difference compared with those on admission(P<0.05);moreoveRthe abovementioned vital signs were much betteRin the study group than in the c

关 键 词：骨盆骨折 失血性休克 急诊 液体复苏 效果 预后 

分 类 号：R683.3[医药卫生—骨科学]