限制性液体复苏治疗肺挫伤合并失血性休克的疗效评价

目的探讨限制性液体复苏对肺挫伤合并失血性休克的治疗效果。方法 163例肺挫伤合并失血性休克病人随机分成充分液体复苏(常规)组(84例)、限制性液体复苏(限制)组(79例)。常规组在止血前早期、快速、足量补液,维持收缩压≥90mmHg(1mmHg=0.133kPa),中心静脉压(CVP)≥5cmH2O(1cmH2O=0.098kPa);限制组在止血前限制液体输入,维持收缩压在80～90mmHg,平均动脉压(MAP)在50～60mmHg,CVP在2～5cmH2O。比较两组患者的平均输液量、病死率及存活患者并发症的发生率。结果平均输液量常规组为(2650±525)ml,限制组为(1780±310)ml,两组比较差异有统计学意义(P<0.01)。常规组死亡20例(23.81%),限制组死亡9例(11.39%),常规组的病死率明显高于限制组(P<0.05)。且常规组存活患者并发急性呼吸窘迫综合征(ARDS)、多脏器功能障碍综合征(MODS)及总并发症的发生率也均高于限制组(P<0.05)。结论限制性液体复苏能降低肺挫伤合并失血性休克患者的病死率,并降低存活患者并发症的发生率,改善预后。

Healing effect of limited fluid resuscitation on pulmonary contusion complicated with hemorrhagic shock

Objective To evaluate the effect of limited fluid resuscitation on pulmonary contusion complicated with hemorrhagic shock.Methods A total of 163 patients with pulmonary contusion complicated with hemorrhagic shock were randomly divided into adequate fluid resuscitation group(n=84,regular group)and limited fluid resuscitation group(n=79,limited group).In the regular group,the patients underwent fast infusion of the full quantity fluid in the early stage before hemostasia,and the systolic blood pressure was kept at ≥ 90 mmHg and central venous pressure(CVP)at ≥ 5cmH2O.In the limited group,fluid infusion was limited before hemostasia,keeping systolic blood pressure at 80-90 mmHg,mean arterial pressure(MAP)at 50-60 mmHg,and CVP at 2-5 cmH2O.Results Average transfusion volumes were(2650±525)ml in the regular group and(1780±310)ml in the limitied group,between which there was a significant difference(P<0.01).The mortality of the regular group was significantly higher than that of the limited group(P<0.05).Furthermore,the complication rate of the survival patients was higher in the regular group than in the limited group(P<0.05).Conclusion Limited fluid resuscitation can reduce the mortality of pulmonary contusion complicated with hemorrhagic shock,and the complications in the survivals.