摘要
目的观察限制性液体复苏救治多发伤合并失血性休克患者的效果。方法将2011年1月-2013年3月解放军251医院急救中心创伤外科收治的多发伤合并失血性休克118例根据休克复苏方法的不同分为常规液体复苏组（A组）和限制性液体复苏（收缩压维持在70～90mmHg，中心静脉压〉2．18mmHg，平均动脉压维持在50～60mmHg）组（B组），每组59例。比较液体复苏45、90、135min后两组动脉血气分析结果、血清乳酸含量及凝血功能；比较液体复苏135min后两组肝肾功能、肿瘤坏死因子-α（TNF-01）、心肌酶谱、红细胞压积（HCT）、胃肠黏膜pH值（pHi），总输液量、失血量、输血量，多器官功能障碍综合征（MODS）、急性肾衰竭（ARF）、弥漫性血管内凝血（DIC）的发生率及病死率。结果复苏后不同时间点，B组氧分压、pH值、碱剩余明显高于A组，二氧化碳分压、血清乳酸明显低于A组，凝血功能指标均优于A组，差异均有统计学意义（P〈0．05）。复苏135rain后，B组肝肾功能、TNF—α、心肌型肌酸激酶同工酶、肌酸激酶、HCT、pHi值明显低于A组（P〈0．05）；B组总输液量、失血量、输血量明显少于A组，MODS、ARF、DIC发生率及病死率明显低于A组，差异均有统计学意义（P〈0．05）。结论限制性液体复苏应用于多发伤合并失血性休克患者的救治获得良好效果，可明显降低患者病死率及后期并发症的发生率。
Objective To observe the effect of restrictive liquid recovery in treatment of multiple trauma compli- cated with hemorrhagic shock. Methods According to the different recovery methods, 118 patients with trauma surgery complicated with hemorrhagic shock during January 2011 and March 2013 were divided into conventional liquid resuscita- tion group （group A, n = 59） and restrictive fluid resuscitation group （ group B, n = 59, systolic blood pressure within 70-90 mmHg, central venous pressure 〉 2.18 mmHg, mean arterial pressure within 50-60 mmHg）. Results of arterial blood gas analysis, serum lactic acid contents and blood coagulation functions at 45^th , 90^th and 135^th min after liquid re- covery in the two groups were compared; functions of liver and kidney, tumor necrosis faetor-α （TNF-α） , myocardial en- zyme spectrum, hematocrits （HCT）, intramucosal ph （pHi） , total transfusion volumes, blood loss volumes, blood trans- fusion volumes, incidence rates and fatality rates of multiple organ dysfunction syndrome （MODS） , acute renal failure （ARF） and disseminated intravascular coagulation （DIC） at 135^th min after liquid recovery in the two groups were also compared. Results At difference times after anabiosis in group B, levels of oxygen partial pressure, pH value and base excess were significantly higher than those of group A, while levels of PaO2 and serum lactic acid were significantly lower than those of group A, and indicators of blood coagulation function in group B were superior to those of group A, and the differences were statistically significant （P 〈 0. 05 ）. At 135^th min after recovery, levels of functions of liver and kidney, TNF-α, myocardium creatine kinase isoenzyme, ereatine kinase, HCT and pHi in group B were significantly lower than those of group A （P 〈 0. 05） ; total transfusion volume, blood loss volume, blood transfusion volume, incidence rate and fatality rate of MODS, ARF and DIC in group B were significantly lower than those of group A （P 〈 0.05）. Conclusion Restrictive fluid resuscitation in treatment of patients with multiple trauma complicated with hemorrhagic shock may achieve good curative effect and obviously reduce the rates of mortality and incidence of complications in a later stage.
出处
《解放军医药杂志》
CAS
2014年第2期54-58,共5页
Medical & Pharmaceutical Journal of Chinese People’s Liberation Army
关键词
多处创伤
休克
出血性
液体复苏
限制性
Muhiple trauma
Shock, hemorrhagic
Liquid recovery, restrictive
