氨甲环酸联合碳酸氢钠注射液+林格氏液对创伤失血性休克合并创伤性凝血病患者的影响  

Effect of Tranexamic Acid Combined with Sodium Bicarbonate Injection and Ringer's Solution on Patients with Traumatic Hemorrhagic Shock and Traumatic Coagulopathy

作　　者：沈蓝 代建能 邓学林 普伦庆 浦同青 苏小梅 SHEN Lan;DAI Jianneng;DENG Xuelin;PU Lunqing;PU Tongqing;SU Xiaomei(Honghe Hospital Affiliated to Kunming Medical University,Mengzi 661199,China;不详)

机构地区：[1]昆明医科大学附属红河医院(云南省滇南中心医院,红河州第一人民医院),云南蒙自661199

出　　处：《中外医学研究》2024年第26期156-160,共5页CHINESE AND FOREIGN MEDICAL RESEARCH

基　　金：云南省科技厅科技计划项目(202301AY070001-040);青岛大学医疗集团科研项目(YLJT20222013)。

摘　　要：目的:探究氨甲环酸联合碳酸氢钠注射液+林格氏液对创伤失血性休克合并创伤性凝血病患者的影响。方法:选取2022年5月—2023年2月昆明医科大学附属红河医院急诊科收治的67例创伤失血性休克合并创伤性凝血病患者作为研究对象,根据入院时间分为两组,2022年5—10月入院的33例纳入对照组,2022年11月—2023年2月入院的34例纳入观察组。两组均给予氨甲环酸和限制性液体复苏,对照组采用醋酸钠林格氏液复苏,观察组采用碳酸氢钠注射液+林格氏液复苏。比较两组氧代谢指标[静脉血氧饱和度(SvO_(2))、氧消耗(VO_(2))和氧输送(DO_(2))]、昏迷程度[格拉斯哥昏迷量表(GCS)]、休克指数、炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)、白细胞介素-6(IL-6)]、凝血功能[活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、凝血酶原时间(PT)]及并发症。结果:两组复苏前氧代谢指标、昏迷程度、休克指数、炎症因子、凝血功能比较,差异无统计学意义(P>0.05);观察组复苏后2 h SvO_(2)、VO_(2)、DO_(2)水平、GCS评分较对照组更高,休克指数及TNF-α、IL-10、IL-6水平较对照组更低,APTT、TT、PT较对照组更短,差异有统计学意义(P<0.05)。观察组并发症总发生率较对照组更低,差异有统计学意义(P<0.05)。结论:氨甲环酸联合碳酸氢钠注射液+林格氏液可以减轻创伤失血性休克合并创伤性凝血病炎症状态,提高氧代谢,改变凝血功能指标,进而提升复苏效果,减轻昏迷程度,降低相关并发症发生率。Objective:To explore the effect of Tranexamic Acid combined with Sodium Bicarbonate Injection and Ringer's Solution on patients with traumatic hemorrhagic shock and traumatic coagulopathy.Method:A total of 67 patients with traumatic hemorrhagic shock and traumatic coagulopathy who admitted to the Emergency Department of Honghe Hospital Affiliated to Kunming Medical University from May 2022 to February 2023 were selected as the study objects,and they were divided into two groups according to the admission time,33 patients admitted from May to October 2022 were included in the control group,34 patients admitted from November 2022 to February 2023 were included in the observation group.Two groups were given Tranexamic Acid and limited fluid resuscitation,the control group was resuscitated with Sodium Acetate Ringer's Solution,and the observation group was resuscitated with Sodium Bicarbonate Injection and Ringer's Solution.The oxygen metabolism indexes[venous oxygen saturation(SvO_(2)),oxygen consumption(VO_(2))and oxygen delivery(DO_(2))],coma degree[Glasgow coma scale(GCS)],shock index,inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-10(IL-10),interleukin-6(IL-6)],coagulation function[activated partial thromboplastin time(APTT),thrombin time(TT),prothrombin time(PT)]and complications were compared between two groups.Result:There were no statistically significant differences in the oxygen metabolism indexes,coma degree,shock index,inflammatory factors and coagulation function between two groups(P>0.05);the levels of SvO_(2),VO_(2),DO_(2) and GCS score in the observation group at 2 h after resuscitation were higher than those in the control group,the shock index and the levels of TNF-α,IL-10 and IL-6 were lower than those in the control group,APTT,TT and PT were shorter than those in the control group,and the differences were statistically significant(P<0.05).The total incidence of complications in the observation group was lower than that in the control group,the difference was statistically signi

关 键 词：限制性复苏 氨甲环酸 碳酸氢钠注射液 失血性休克 创伤性凝血病 凝血功能 氧代谢 

分 类 号：R605.971[医药卫生—急诊医学]