创伤失血性休克救治中液体复苏链式管理的效果

目的探讨适用于创伤失血性休克救治不同阶段的液体复苏方式,以求证链式管理的液体治疗效果。方法采用历史对照研究,选择2011年7月至2013年6月送达本院的创伤失血性休克患者42例为链式管理组,护士主动参与液体治疗计划,将院前-急诊科-手术室-ICU-外科病房不同科室的液体复苏方式进行链式组合管理;选择2009年7月至2011年6月送达本院的创伤失血性休克患者40例为常规对照组。对比分析两组的复苏开始时间、休克纠正时间、术前输液量、术后72h日均输液量、病死率与并发症指标。结果两组复苏开始时间、术前输液量比较差异无统计学意义(均P0.05);两组休克纠正时间、术后72h日均输液量、病死率及并发症发生率比较差异有统计学意义(P0.05或P0.01)。结论创伤失血性休克患者的液体复苏治疗须兼顾休克病理演变过程与外科围手术期的体液变化,对不同阶段的液体复苏方式进行全程链式管理,有助于实现院内液体复苏的一体化跟踪模式,提高早期抢救成功率,降低后期并发症的发生。

Effectiveness of Chain Management of Fluid Resuscitation in Treatment of Traumatic Hemor-rhagic Shock

Objective To discuss the fluid resuscitation at different stages in treatment of traumatic hem-orrhagic shock,in order to verify the effect of chain management of fluid therapy.Methods By using his-torical control trial,42 trauma patients with hemorrhagic shock in our hospital from July 2011 to June 2013 were selected as the chain management group,and the nurses participate in the treatment plan actively, using the chain management of the fluid resuscitation in different department of pre-hospital,emergency room,operation room,ICU and surgical ward.40 trauma patients with hemorrhagic shock were selected as the control group from July 2011 to June 2013.Compare and analyze two sets of recovery start time,shock correct time,preoperative transfusion,postoperative 72h daily fluid volume,and mortality and complica-tions indicators.Results The difference of the recovery start time and preoperative transfusion volume of two groups was not statistically significant （all P〉0.05 ）.The difference of the shock correct time, postoperative 72h daily fluid volume,mortality and complications indicators were statistically significant （P〈0.05 or P〈0.01）.Conclusion The pathology process of shock and the diversification of the body fluid in perioperative are taken into account to the fluid resuscitation in treatment of traumatic hemorrhagic shock.The chain management of the fluid resuscitation can realize the integration of the tracking mode of hospital resuscitation,improve the success rate of early rescue and reduce the incidence of complications.