乳酸钠林格液、碳酸氢钠林格液及醋酸钠林格液在创伤失血性休克液体复苏中的效果比较  

Comparison of the Effects of Sodium Lactate Ringer's Solution,Sodium Bicarbonate Ringer's Solution,and Sodium Acetate Ringer's Solution in Fluid Resuscitation due to Trauma Hemorrhagic Shock

作　　者：霍延伟 范小强 HUO Yanwei;FAN Xiaoqiang(Department of Emergency,Norinco General Hospital,Xi'an Shaanxi 710065)

机构地区：[1]兵器工业总医院急诊科,陕西西安710065 [2]宝鸡市凤翔区医院急诊科,陕西宝鸡721400

出　　处：《医学临床研究》2024年第12期1878-1881,共4页Journal of Clinical Research

摘　　要：【目的】比较乳酸钠林格液、碳酸氢钠林格液以及醋酸钠林格液在创伤失血性休克(THS)液体复苏中的效果。【方法】行THS液体复苏的多发组织或器官损伤患者306例,随机分为A组、B组、C组三组,每组102例。A组、B组、C组分别应用乳酸钠林格液、碳酸氢钠林格液、醋酸钠林格液进行复苏。比较三组患者复苏前后血清炎症因子、血气指标、凝血功能水平,并发症发生情况及院内病死率。【结果】复苏后,三组肿瘤坏死因子-α(TNF-α)与白细胞介素-6(IL-6)水平较复苏前均升高,变化幅度为A组>B组>C组(均P<0.05);动脉血乳酸(Lac)水平较复苏前均降低,动脉血pH较复苏前均升高,变化幅度为B组>C组>A组(均P<0.05);三组患者动脉氧分压(PaO_(2))、血氧饱和度(SaO_(2))较复苏前均升高,但各组间比较,差异均无统计学意义(均P>0.05);复苏后,三组患者活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)较复苏前均延长,变化幅度为C组<B组<A组(P<0.05);B组与C组多器官功能障碍综合征发生率与院内病死率均低于A组(P<0.05),B组与C组比较,差异无统计学意义(P>0.05)。【结论】醋酸钠林格液与碳酸氢钠林格液在液体复苏中的效果总体优于乳酸钠林格液,其中醋酸钠林格液抑制炎症反应与保障凝血功能作用效果最优,其次为碳酸氢钠林格液,对于发生肝、肾等器官功能障碍的患者应慎用乳酸钠林格液。【Objective】To compare the effects of sodium lactate Ringer's solution,sodium bicarbonate Ringer's solution,and sodium acetate Ringer's solution in fluid resuscitation caused by trauma hemorrhagic shock(THS).【Methods】A total of 306 patients with multiple organ or tissue injuries undergoing fluid resuscitation caused by THS were randomly divided into three groups:Group A,Group B,and Group C,with 102 patients in each group.Group A was resuscitated with sodium lactate Ringer's solution,Group B with sodium bicarbonate Ringer's solution,and Group C with sodium acetate Ringer's solution.Blood serum inflammatory factors,blood gas indicators,coagulation function levels,incidence of complications,and in-hospital mortality rates were compared among three groups before and after resuscitation.【Results】After resuscitation,levels of tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)in all three groups were elevated compared to pre-resuscitation levels,with the greatest change in Group A,followed by Group B,and then Group C(all P<0.05).Arterial blood lactate(Lac)levels were reduced,and arterial blood pH levels increased after resuscitation in all three groups,with the most significant improvement in Group B,followed by Group C then Group A(all P<0.05).Oxygen partial pressure(PaO_(2))and oxygen saturation(SaO_(2))increased after resuscitation in all three groups,but the differences among groups were not statistically significant(all P>0.05).After resuscitation,activated partial thromboplastin time(APTT)and prothrombin time(PT)levels were elevated in all groups,with the smallest increase in Group C,followed by Group B and Group A(P<0.05).The incidence of multiple organ dysfunction syndrome and in-hospital mortality rates in Group B and Group C were lower than that in Group A(P<0.05),while there were no significant differences between Group B and Group C(P>0.05).【Conclusion】Sodium acetate Ringer's solution and sodium bicarbonate Ringer's solution were generally more effective than sodium lactate Ringer's solut

关 键 词：休克 出血性 休克 创伤性 乳酸林格溶液 林格氏液 复苏术 

分 类 号：R605.971[医药卫生—急诊医学]