创伤失血性休克早期液体复苏策略及氧代谢监测的临床观察

目的:观察创伤失血性休克限制性液体复苏及充分液体复苏的临床疗效及对氧代谢的影响。方法:将218例创伤失血性休克患者随机分为治疗组(n=110)及对照组(n=108),分别进行限制性液体复苏及充分液体复苏。比较两组输液量、病死率及并发症(ARDS、MODS、脓毒血症)发生率,复苏2 h后氧输送(DO-2)、氧消耗(VO2)、混合静脉血氧饱和度(SVO2)情况及24 h乳酸恢复情况。结果:治疗组输液量显著少于对照组(P0.01),治疗组死亡率、并发症发生率明显低于对照组(P0.05);治疗组DO_2、VO_2、SVO_2及24 h乳酸恢复正常例数均明显高于对照组(P0.05)。结论:与充分液体复苏比较,对创伤失血性休克进行限制性液体复苏能减少输液量,降低病死率及并发症发生率,且在组织供氧及纠正乳酸酸中毒方面有明显优势。

The Clinical Observation for Uncontrolled Hemorrhagic Traumatic Shock by Early Fluid Resuscitation and Monitoring of Oxygen Metabolism

Objective：To observe the clinical effects for uncontrolled hemorrhagic traumatic shock by limited fluid resuscitation and the influence to oxygen metabolism. Methods：218 patients with uncontrolled hemorrhagic shock were randomly divided into treatment group（n=110） and control group （ n=108 ） treated by limited fluid resuscitation and fully fluid resuscitation respectively.The transfusion amount, mortality and incidence of complications （ARDS, MODS, sepsis）, the DO2, VO2 and SVO2 after recovery 2 h and lactic acid normal cases after 24 h were compared between the two groups. Results： The transfusion amount, the mortality and incidence of complications in the treatment group were significantly less than those in the control group （P〈0.01 or P〈0.05）. The DO2,VO2,SVO2 and the lactic acid normal cases after 24 h in the treatment group were significantly higher than those in the control group（P〈0.05）. Conclusion：Compared with fully fluid resuscitation for patients with uncontrolled hemorrhagic shock,limited fluid resuscitation can reduce the transfusion amount, mortality and incidence of complications, and it＇s better supply oxygen and currect lactic acidosis.