骨髓腔输液结合深静脉置管在急诊低血容量休克患者中的应用

目的探讨骨髓腔快速补液结合深静脉置管在抢救急诊低血容量性休克患者中的应用价值。 方法回顾性分析2014年3月至2017年3月南京鼓楼医院集团宿迁市人民医院急诊科及烧伤整形科就诊的127例低血容量性休克患者资料，其中男性79例，女性48例；年龄5～81岁，平均(37.4 ±5.6)岁。所有患者均在就诊后的第一时间快速建立骨髓腔输液通道进行快速扩容补液，再根据患者情况建立合适的深静脉置管通道进行积极的抗休克治疗。 结果采用骨髓腔途径快速补液的127例患者中，有10例(7.87%)因严重创伤等原因，在入院时已濒临死亡，经抢救无效死亡；117例(92.13%)患者安全度过休克期进入相关专科进一步治疗。随访发现17例(13.39%)患者因原发的疾病或损伤加重死亡。余100例(78.74%)患者连续随访3～6个月，未见造血系统功能障碍或骨髓炎表现。所有患者的深静脉置管均未检测出导管相关性感染细菌。 结论骨髓腔快速补液结合深静脉置管补液在急诊低血容量性休克患者的抢救中有较大的使用价值。

Combination of intraosseous infusion and deep vein catheterization for treatment of hypovolemic shock patients in emergency department

ObjectiveTo investigate the effect of rapid intraosseous infusion rehydration combined with deep venous catheterization in patients with acute hypovolemic shock. MethodsA retrospective analysis was conducted, which included 127 patients with hypovolemic shock treated in emergency room from March 2014 to March 2017. There are 79 males and 48 females, aged from 5 to 81 years old, average age (37.4±5.6)years. After each patient was admitted to the hospital, an intraosseous infusion channel was quickly established for rapid rehydration, followed by deep venous catheterization to continue expansion of blood volume. The control group of 116 patients with hypovolemic shock did not receive intraosseous infusion. The success rate of anti-shock treatment and the time of deep vein catheterization were compared between the two groups. ResultsOf the 127 patients, 10(7.87%) were dying on admission due to severe trauma and died after being rescued, and the other 117 patients (92.13%) survived in the hypovolemic-shock period and were admitted to the relevant specialties for further treatments. There were no hematopoietic dysfunction, myelitis or catheter-related infection of the deep vein catheter in the other patients during the 6 month follow-up. The successful rate of resuscitation by intraosseous infusion was better than that of the control group. There was no significant difference in the time of deep vein catheterization. ConclusionsCombination of intraosseous infusion and deep vein catheterization is of great value forhypovolemic shock patients in the emergency.