限制性补液对肺挫伤伴失血性休克的影响

目的 观察限制性补液对肺挫伤伴失血性休克病人的治疗效果.方法 将2008年1月-2010年3月共救治肺挫伤伴失血性休克的病人（ISS≥25）78例,随机分为限制组（40人）和常规组（38人）.两组患者均因严重低氧血症和失血性休克行机械通气和体液复苏.分别监测凝血功能（PT和APTT）、碱剩余（BE）、血浆乳酸含量、氧分压、氧合指数及胸片变化情况,统计两组肺挫伤伴失血性休克病人的呼吸机通气时间、住ICU时间、急性呼吸窘迫综合症（ARDS）和多器官功能障碍综合征（MODS）发生率、治愈率和死亡率.结果 限制性补液 与常规补液均能明显降低PT、APTT、BE值和血清乳酸含量;而限制组比常规组更能减少病人 胸部进一步渗出,提高患者氧分压、氧合指数,降低呼吸机通气时间、住ICU时间、ARDS和 MODS的发病率及死亡率,增加治疗率（P〈0.05）.结论 限制性补液能有效改善肺挫伤伴失血性休克病人凝血紊乱,缓解酸中毒,明显比常规组促进肺部修复,提高肺组织氧合能力,提高患者预后和生存率.

Effects of infusion restriction on pulmonary contusion with hemorrhagic shock

Objective To explore the effect of infusion restriction on pulmonary contusion with hemorrhagic shock.Methods Seventy-eight patients (ISS≥25) with pulmonary contusion and hemorrhagic shock who had been hospitalized from January 2008 to March 2010 were included in this study.All the patients required mechanical ventilation and fluid rescue because of severe hypoxia and shock and were randomly divided into conventional group (n = 38) and restriction group (n = 40).FT,APTT,BE,lactic acid content,PO2,PO2/FiO2,and changes in chest radiology were determined; ventilation time,length of ICU stay,the motality,incidence,and curative rate of ARDS or MODS were studied in the two groups.Results FT,APTT,BE,and lactic acid content were lower in both restriction group and convertional group.As compared with conventional group,PO2,PO2/FiO2,and pulmonary inflammatory absorption were elevated (P<0.05),ventilation time and length of ICU stay were shortened,the mortality and incidence of ARDS or MODS were reduced (P<0.05),and the curative rate was increased in restriction group (P<0.05).Conclusions Infusion restriction in the treatment of pulmonary contusion with hemorrhagic shock can effectively improve coagulopathy and relieve acidosis and it markedly promotes pulmonary repair and increases the survival rate and the prognosis.