抢救48例创伤失血性休克的护理体会

“安全、畅通、规范、高效”是医院急诊科“绿色通道”的目标，是提高抢救成功率的基点，是发展的方向。我院急诊科通过对48例创伤失血性休克病人，进行抢救和护理的初探，体会如下：     

36例宫外孕失血性休克患者的抢救护理研究

目的：探讨宫外孕失血性休克患者的抢救与术后护理疗效。方法选取2012年1月～2013年12月本院收治的宫外孕失血性休克的36例患者,观察其抢救与术后护理疗效。结果患者均治愈出院,住院时间6～12d,平均（8.13±2.15）d,治愈率为100%。所有患者的切口均甲级愈合,术后并发症少、恢复快。结论对于宫外孕失血性休克患者,积极的进行抢救和术后护理干预,可明显的提高患者的救治成功率。     

骨盆骨折合并失血性休克的急救与护理

目的:探讨骨盆骨折合并失血性休克患者的急救与护理.方法:结合16例骨盆骨折合并失血性休克患者的早期救治和护理方法.结论:骨盆骨折合并失血性休克患者在短期内救治不及时,会危及生命.因此,我们应该规范骨盆骨折合并失血性休克的早期急救技能和护理技术.结果:16例骨盆骨折均发生失血性休克,其中15例治愈出院,1例死亡.     

骨盆骨折并失血性休克的急救与护理

目的:探讨对骨盆骨折并失血性休克病人有效的急救与护理措施。方法:通过回顾性总结分析18例该类病人的临床救治与护理过程,总结有效的急救与护理措施。结果:18例病人除1例病情严重合并多发伤死亡外,余17例均治愈出院。结论:①积极而有效的急救措施是抢救休克的关键;②迅速补充血容量,恢复有效的循环血量,保证足够的尿量,保持呼吸道通畅,改善缺氧是纠正休克的重要措施;③全面而细致的观察病情,是早期发现合并损伤,预防并发症的重要手段。     

小儿失血性休克手术急救的护理

目的探讨小儿失血性休克手术急救成功的护理方法与措施,提高手术抢救成功率。方法回顾性分析22例小儿失血性休克手术急救成功的护理措施。结果 22例病人全部抢救成功,无1例死亡。结论良好的手术室护理工作是小儿失血性休克病人救治的关键。     

创伤失血性休克的临床护理及体会

目的通过对创伤失血性休克的临床护理，达到提高疗效，缩短疗程，提高抢救成功率的目的。方法临床对症护理。结果24例患者均获抢救成功。结论通过对创伤性休克患者的临床护理，可以达到提高疗效，缩短疗程，提高抢救成功率的目的。     

安全限度稀释血液抢救失血性休克

近年来 ,用稀释血液的方法抢救失血性休克越来越受到重视。我院用安全限度稀释血液的方法补充血容量和微循环灌注 ,提高组织供氧 ,减少产生自由基和减轻心脏负荷 ,提高抢救的成功率。为观察其疗效 ,将病人分为“调整血液浓度补液法”(观察组 )和“非调整血液浓度补液法”(对照组 )进行对照分析 ,现将结果报道如下。1　资料与方法1 1　资料　休克指数 >1 5、收缩压 <70ｍｍＨｇ ;Ｈｂ>110ｇ/Ｌ、Ｈｃｔ>0 4。共 6 0例 (年龄 2 0～ 4 6岁。男5 5例 ,女 5例 )。1 2　分组　对照组 :根据休克指数[1] 估计失血量补液 ,补液量 15 0 0～ 4 0 0 0ｍ…     

浅谈肢体骨折合并失血性休克的预见性护理

肢体骨折合并失血性休克是护理救治工作中的急症,要求护理人员能检伤迅速,认诊准确,护理超前,处置严格,以保证病人生命的延续,为后续治疗提供时间与保证。现将38例患者的预见性护理初步体会报告如下。1 临床资料 本组38例,男21例,女17例;年龄12～71岁,骨折部位总计116处,最多骨折部位5处,最少骨折1处,平均骨折3.1处。其中上肢骨折45处,下肢骨折58处,并发其它骨折13处。经救治38例全部存活。     

重度失血性休克患者的手术室护理体会

目的总结重度失血性休克患者的手术室护理措施体会。方法对42例重度失血性休克患者实施基础、呼吸道、观察病情及手术配合等各项护理措施,回顾性分析患者的临床资料。结果本组40例(95.2%)患者生命体征和原发症状得到明显改善,2例患者抢救无效死亡。结论对重度失血性休克患者,手术室实施各项精心护理,可有效提高患者的抢救成功率,改善患者生活质量。     

输卵管积水穿刺术后急性失血性休克伴DIC经验教训1例

输卵管积水穿刺抽吸术后出现的急性失血性休克伴DIC极其少见,容易造成误诊和救治不及时。本文回顾分析了1例36岁已婚女性,因冷冻胚胎移植前发现输卵管积水行输卵管积水穿刺抽吸术,术后36h出现以腹痛为首发症状,继而出现急性失血性休克和DIC表现,行剖腹探查未发现明显出血点,后行选择性动脉造影+栓塞术后,患者逐渐恢复意识。病情稳定后行腹膜后血肿清除术,术后12d痊愈出院。本病例警示我们要合理使用抗凝药物,在无法明确出血点的急性大量失血情况下,应尽早进行选择性动脉造影+栓塞术,避免病情恶化。     

重症胆道感染围手术期合并弥散性血管内凝血的诊断和治疗

目的 探讨围手术期重症胆道感染合并DIC的早期诊断和综合治疗的效果.方法 对21例重症胆道感染合并DIC的病人进行综合性治疗,监测治疗前后病人的凝血功能.结果 21例病人中,治愈19例,死亡2例,治愈率90.5%.治疗前与治疗后相比,出血倾向得到控制,腹腔出血停止,病人的凝血酶原时间(PT)明显缩短,纤维蛋白原(Fbg)含量增加,D-二聚体及FDPs水平明显下降.结论 围手术期重症胆道感染病人易合并DIC,且病死率高,早期明确诊断并进行有效的综合性治疗是关键,尤其是冷沉淀联合低分子肝素的应用.     

The effect of various resuscitative regimens on hemorrhagic shock in puppies

Since shock secondary to hemorrhage is not infrequently encountered in the pediatric patient, a puppy model was devised to help measure and monitor cardiovascular and metabolic changes that occur before and after resuscitation from hypovolemic shock (mean arterial pressure of 50 mm Hg for 1 hr). Three resuscitation protocols were compared: whole blood (replacement: shed) 1:1, 5% albumin in Ringer's lactate 1:1, and Ringer's lactate 3:1. All dogs survived the experiment and responded similarly during the shock period. Thermal dilution cardiac output rose in all groups after resuscitation; however, in the Ringer's lactate and 5% albumin groups, cardiac output was statistically greater than that observed in the blood group. In all groups, pH and blood pressure approached but did not return completely to baseline levels after resuscitation. In addition, early resuscitation demonstrated a further decrease in pH (“hidden acidosis”) before it began to return toward normal as resuscitation progressed. This study suggests that the infusion of large volumes of Ringer's lactate or 5% albumin in Ringer's lactate are equally efficacious in the treatment of hemorrhage. However, 5% albumin seems to be preferable because it allows infusion of a smaller quantity of electrolyte solution with equivalent physiologic benefits.     

Syndromes with renal failure and shock

Renal failure occurs commonly in children with shock, coagulopathy and multi-organ failure. Successful management of these patients requires not only management of the renal failure, but recognition and treatment of the underlying process. In addition to common and wellrecognised causes of renal failure and shock, such as Gramnegative sepsis, there are a number of syndromes which are either less well recognised or confined to specific geographic locations. This article reviews the clinical and epidemiological features of the syndromes with shock and renal failure, focusing on the more recently recognised syndromes such as staphylococcal and streptococcal toxic shock syndrome, haemorrhagic shock and encephalopathy syndrome and viral haemorrhagic fevers.     

四种不同复合液对急性颅内高压伴失血性休克兔复苏的效果及其机制

目的 探讨4种不同复合液体对急性颅内高压伴失血性休克兔复苏的效果及机制.方法 家兔24只,随机分为甘露醇羟乙基淀粉组( MT+ HS)组、甘露醇低分子右旋糖酐组(MT+HD)组、7.5％高渗氯化钠羟乙基淀粉组(HSH)组、7.5％高渗氯化钠低分子右旋糖酐组(HSD)组,每组6只,采用硬膜外球囊注水和动脉放血的方法复制急性颅内高压伴失血性休克模型,分别于8个不同时点采集平均动脉压(MAP)、中心静脉压(CVP)、颅内压(ICP)、脑灌注压(CPP)数据.结果 4组复合液均能提高MAP,HSH组在复苏后20 min达到峰值,反应速度最快,提高MAP的平均幅度分别为(29.4±2.1)、(27.9±3.4)、(41.0±2.2)、(40.6±1.6) mm Hg(1 mm Hg =0.133 kPa),提高幅度差异有统计学意义(P＜0.05);4组复合液提高CVP值的幅度均接近于(3.0±1.4) cm H2O(1 cm H2O =0.098 kPa),提高幅度差异无统计学意义(P＞0.05);4组复合液均能在不同时段将ICP值降至基础值水平(7.3±1.6) mmHg,将CPP值升至基础值水平(69.6±6.8)mm Hg,峰值水平差异无统计学意义(P＞0.05).结论 4组复合液均有纠正休克和降低颅内压的效果,HSH维持效用的时间最持久,复苏效果最明显.     

高渗氯化钠羟乙基淀粉40注射液对失血性休克大鼠凝血功能的影响

目的 观察高渗氯化钠羟乙基淀粉40注射液(高渗晶胶液)对失血性休克大鼠复苏过程中凝血功能的影响.方法 16只SD大鼠随机均分为高渗晶胶液复苏组(H组)和复方乳酸钠复苏组(L组),将16只SD大鼠制成失血性休克模型后,分别使用高渗晶胶液和复方乳酸钠各6 ml/kg进行复苏,在休克前(T1)、休克后60 min(复苏前,T2)及复苏后5 min(T3)、30 min(T4)、60 min(T5)时记录血压,取血浆分别测定出血时间(BT)、凝血时间(TT)、凝血酶原时间(PT)、白陶土部分凝血活酶时间(KPTT)和纤维蛋白原(Fib).结果 两组在T2～T5时BT、TT、PT、KPTT均明显长于T1时(P<0.05),Fib明显低于T1时(P<0.05);H组在T3～T5时BT、TT、PT、KPTT均明显短于L组(P<0.05);两组之间Fib在各时点差异无统计学意义.结论 高渗晶胶液对失血性休克凝血功能有影响,使BT、TT、PT、KPTT延长,Fib降低,但尚未超过机体的代偿范围.应用高渗晶胶液进行液体复苏时应在临床推荐剂量内,同时加强凝血功能的监测和控制.     

The inflammatory sequelae of aortic balloon occlusion in hemorrhagic shock

Background

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a hemorrhage control and resuscitative adjunct that has been demonstrated to improve central perfusion during hemorrhagic shock. The aim of this study was to characterize the systemic inflammatory response associated and cardiopulmonary sequelae with 30, 60, and 90 min of balloon occlusion and shock on the release of interleukin 6 (IL-6) and tumor necrosis factor alpha.

Materials and methods

Anesthetized female Yorkshire swine (Sus scrofa, weight 70–90 kg) underwent a 35% blood volume–controlled hemorrhage followed by thoracic aortic balloon occlusion of 30 (30-REBOA, n = 6), 60 (60-REBOA, n = 8), and 90 min (90-REBOA, n = 6). This was followed by resuscitation with whole blood and crystalloid over 6 h. Animals then underwent 48 h of critical care with sedation, fluid, and vasopressor support.

Results

All animals were successfully induced into hemorrhagic shock without mortality. All groups responded to aortic occlusion with a rise in blood pressure above baseline values. IL-6, as measured (picogram per milliliter) at 8 h, was significantly elevated from baseline values in the 60-REBOA and 90-REBOA groups: 289 ± 258 versus 10 ± 5; P = 0.018 and 630 ± 348; P = 0.007, respectively. There was a trend toward greater vasopressor use (P = 0.183) and increased incidence of acute respiratory distress syndrome (P = 0.052) across the groups.

Conclusions

REBOA is a useful adjunct in supporting central perfusion during hemorrhagic shock; however, increasing occlusion time and shock results in a greater IL-6 release. Clinicians must anticipate inflammation-mediated organ failure in post-REBOA use patients.     

Successful perioperative management of a patient with idiopathic thrombocytopenic purpura undergoing emergent appendectomy: Report of a case

INTRODUCTIONIdiopathic thrombocytopenic purpura (ITP) is an autoimmune disease characterized by a low platelet count and normal bone marrow. Patients with ITP undergoing surgery are thought to have increased risk for postoperative complications because of their thrombocytopenia.PRESENTATION OF CASEwe report the case of a 66-year-old woman with ITP who required an emergency operation for acute appendicitis associated with disseminated intravascular coagulation. Preoperative therapy consisted of platelet transfusions only, and intraoperative hemostasis was achieved. Postoperatively, high-dose intravenous immunoglobulin (IVIg) therapy led to an increased, stable, and adequate platelet count and good hemostasis.DISCUSSIONThe outcome of this case suggests that IVIg therapy is not always required for preoperative management of patients with.CONCLUSIONIVIg therapy may be useful for postoperative management after emergency surgery.     

高氧液在抢救重度失血性休克中的临床应用

目的　观察高氧液对重度失血性休克患者血压和微循环的影响。方法　选择重度失血性休克患者 6 0例 ,随机分为治疗组和对照组 ,每组 30例。每组在抢救中除采用止血、输血、输液等相同措施外 ,对照组输入复方乳酸钠 10～ 2 0ml/kg ;治疗组输入等量的高氧液。两组同步观测血压、尿量、血气恢复正常及末梢循环改善所需要的时间。结果　治疗组血压、尿量、血气恢复正常及末梢循环改善所需要的时间均较对照组少 (P <0 0 1)。结论　高氧液对重度失血性休克有稳定血压和改善微循环的作用。     

组蛋白脱乙酰化酶抑制剂对失血性和感染性休克早期救治作用的研究进展

背景 休克早期的药物救治,一直普遍受到关注,近来组蛋白脱乙酰化酶抑制剂(histone deacetylase inhibitors,HDACI)因其突出的抗休克作用成为国际研究热点. 目的 回顾目前HDACI的临床应用方向和分类,讨论其作为抗失血性休克和感染性休克药物的突出优势以及作用机制. 内容 HDACI可通过抗细胞凋亡等多种途径,提高细胞对休克所致缺血/缺氧环境的耐受能力,改善失血性休克和感染性休克动物模型的预后. 趋向 HDACI已成为抗失血性休克和感染性休克研究的新方向,是提高休克早期生存率的新策略,也为休克的治疗提供了药物配合液体复苏的新途径.