限制性液体复苏在肝脾损伤合并失血性休克术前的临床应用

目的探讨限制性液体复苏对肝脾损伤合并失血性休克术前临床疗效。方法 2006年1月—2011年11月本院急诊科救治的47例肝脾破裂合并失血性休克患者,分为常规液体复苏组(A组23例)和限制性液体复苏组(B组24例),对比两组手术前输入液体量、血清乳酸含量、凝血酶原时间(PT)及红细胞比积(HCT)等指标,对比两组术后患者存活率、多器官功能衰竭(MODS)、腹腔间隙综合征(ACS)的发生率。结果 A组术后的死亡率、MODS发生率、ACS发生率均高于B组(P<0.05),B组红细胞比积明显高于A组,B组凝血酶原时间较A组无明显延长(P均<0.05),B组血清乳酸水平与A组相当(P>0.05)。结论限制性输液在肝脾损伤合并失血性休克的术前救治中取得良好的疗效,明显降低术后死亡率及并发症的发生率。

Clinical application of limited fluid resuscitation in treatment before operation of hepatic and splenic injury and haemorrhagic shock

Objective To analyze the clinical efficacy of limited fluid resuscitation in treatment before operation of hepatic and splenic injury and haemorrhagic shock. Methods Forty seven cases of hepatic and splenic injury and haemorrhagic shock in emergency department of our hospital since January 2006 to November 2011 were divided into conventional fluid resuscitation group(Group A,n=23) and limited fluid resuscitation group(Group B,n=24).The fluid volume,serum lactic acid content,prothrombin time(PT) and hematocrit(HCT) before the operation and the survival rate,the incidence rate of multiple organ dysfunction syndrome(MODS) and abdominal compartment syndrome(ACS) after the operation were compared between the two groups. Results The mortality,incidence rate of MODS and ACS were higher in Group A than in Group B(P<0.05).The hematocrit in Group B was higher than in Group A,the prothrombin time of Group B showed no significantly prolonged compared with Group A(P<0.05).Serum lactic acid content in two groups were roughly equal(P<0.05). Conclusion The application of limited fluid resuscitation in treatment before operation of hepatic and splenic injury and haemorrhagic shock achieved good efficacy,significantly reduce the postoperative mortality and the incidence of complications.