摘要
目的 分析限制性液体复苏联合体温管理对严重多发伤失血性休克患者的应用效果.方法 回顾性分析2018年1月至2020年1月在温州医科大学附属第二医院就诊的90例严重多发伤失血性休克患者的临床资料,按治疗方法不同分为联合治疗组和单纯治疗组,每组45例.患者入院后均开通绿色通道给予紧急抢救,监测各项生命体征并进行相关检查.单纯治疗组患者给予限制性液体复苏方案,即早期快速输注林格液和6%右旋糖酐等渗盐溶液,将动脉血压总体控制在60-80mmHg(1mmHg≈0.133kPa),如补液后血压未升高,则同时给予盐酸多巴胺微量泵注;联合治疗组在单纯治疗组基础上纠正体温.采用超声诊断仪监测两组患者心排血量(CO)、心排血指数(CI)、全心舒张末期容积指数(GEDVI)等心功能指标;采用血气生化仪检测两组患者动脉血乳酸(Lac)水平;采用血凝分析仪测定两组患者的活化部分凝血活酶时间(APTT)、凝血酶原时间(PT);记录两组患者治疗期间并发症发生率和病死率.结果 复苏后,两组患者CO、CI和GEDVI水平均明显高于入院时,且联合治疗组均明显高于单纯治疗组〔CO(L/min):3.61±0.68比3.20±0.61,CI(L·min^-1·m^-2):4.76±0.44比4.15±0.51,GEDVI(mL/m^2):757.12±70.56比712.79±74.03,均P<0.05〕;两组患者PT、APTT水平均明显高于入院时,动脉血Lac明显低于入院时,且联合治疗组PT、APTT、Lac均明显低于单纯治疗组〔PT(s):12.31±2.33比14.07±2.68,APTT(s):30.08±5.81比34.98±3.02,Lac(mmol/L):1.71±0.28比2.44±0.12,均P<0.05〕.联合治疗组的并发症发生率〔11.11%(5/45)比31.11%(14/45)〕和病死率〔2.22%(1/45)比15.56%(7/45),P<0.05〕均明显低于单纯治疗组,差异均有统计学意义(均P<0.05).结论 限制性液体复苏联合体温管理纠正能显著改善严重多发伤失血性休克患者的心功能和凝血功能,降低病死率和并发症发生率,具有较好的临床应用价值.
Objective To analyze the efeet of restrictive Aluid resuscitation combined with body lemperalure corrective management on patients with severe multiple trauma and hemorhagic shock.Methods The edlinical data of 90 patients with severe multiple trauma and hemorrhagic shock who were treated in the Second Afiliated Hospital of Wenzhou Medical University from January 2018 to January 2020 were retrospectively analyzed.According to difference in treatment methods,the patients were divided into a combination Irealment group and a routine treatment group,with each group 45 cases.After the patients were admitted to the hospital,green channel was opened for emergency rescue,vital signs were monitored and relevant examinations were carried out.The patients in routine treatment group were given imited fluid resuscitation therapy.that was in the early slage.Ringer's solution and 6%dextran isotonie salt solution were infused rapidly to control the arterial blood pressure at 60-80 mmHg(1 mmHg≈0.133 kPa),if the blood pressure did not elevate after fluid infusion or rehydration,dopamine hydrochloride was infused by micro pump at the same time;the combination treatment group was given temperature correction on the hasis of management in routine treatment group.In both groups,the cardiac funetion indexes such as cardiae oulpul(CO),cardiac output index(CI),global end-diastolic volume index(GEDVI),etc were monitored by ultrasonic diagnostic instrument;the levels of arterial blood lactate(Lac)was measured by blood gas biochemical instrument;aetivated partial thromboplastin time(APTT)and prothrombin time(PT)were detected by hemagglutination analyzer.During the therapeutic time,the complication and mortality incidence of the two groups were recorded.Results After resuscitation,the levels of CO,CI and GEDVI in two groups were significantly higher than those al admission in the two groups,and the levels of CO,CI and GEDVI in combination treatment group were significantly higher than those in routine treatment group[C0(L/min):3.61±0.68 vs.3.20±0.61,CI(L·min^-1·m^-2):4.76±0.44 vs.4.15±0.51.GEDVI(mL/m^2):757.12±70.56 vs.712.79±74.03,all P<0.05];in the two groups,the levels of PT,APIT were significantly higher than those at admission,while the level of arterial blood Lac was obviously lower than that at admission,and the levels of PT.APTT and Lac in combination treatment group were significantly lower than those in routine treatment group[PT(s):12.31±2.33 vs.14.07±2.68,APTT(s):30.08±5.81 vs.34.98±3.02,arterial Lac(mmol/L):1.71±0.28 vs.2.44±0.12,all P<0.05].The ineidence of complications[11.11%(5/45)vs.31.11%(14/45),P<0.05]and the mortality[2.22%(1/45)vs.15.56%(7/45),P<0.05]in combination treatment group were significanly lower than those in routine lreatment group.Conclusion The ffect of using combination of limited fluid resuscitation and body temperature corrective management is better than that applying limited luid resuscitation alone for treatment of patients with severe muliple trauma and hemorhagie shock,as the combined group can more significantly improve the cardiac and blood coagulation functions and reduce the mortality and incidence of complications,possessing relatively good clinical application value.
作者
金呀曼
金楚珍
陈王峰
黄小燕
Jin Yaman;Jin Chuzhen;Chen Wangfeng;Huang Xiaoyan(Anesthesin Recovery Room,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,Zhejiang,China;Department of Intensive Care Unit,the Second Afiliated Hospital of Wenzhou Medical Universiy,Wenzhou 325000,Zhejiang,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2020年第5期608-611,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
浙江省温州市公益性科技计划项目(Y20170456)。
关键词
限制性液体复苏
体温管理
失血性休克
多发伤
Limited fluid resuscitation
Body temperature management
Henorhagie shock
Trauma.muliple
