危重地震伤员术中容量治疗

目的分析2008年5月12日-2008年6月11日行手术治疗的汶川地震危重伤员（ASA3～5）的围术期容量治疗，总结经验与教训，为以后可能实施的大规模伤员手术救活中容量治疗提供参考。方法收集整理所有危重地震伤员术中输液、输血记录及血液学检查指标，观察术前术后血红蛋白（Hb）、血细胞比容（Hct）和血小板计数（Plt）的变化。结果我院共对危重伤员行手术治疗244台次，术中输注晶体液、胶体液、血液制品行容量治疗，其中输血治疗167台次，共计用血液制品118500ml，其中RBC80200ml（67．68％），FFP38300ml（32．32％）。术后有55例次（32．8％）的伤员的Hb、Hot、Ph均较术前下降，Hb从78～142g／L降至56～108g/L，Het从25％～38％降至15％～25％、Pit从（186—256）×10^9／L降至（73—129）×10^9／L；有61.1％（102例）伤员术后Hb、Hct、Plt上升，Hb从47～97g/L升至88—145g／L，Hot从18％-29％升至26％-41％，Pit从（66～123）×10^9／L升至（118—263）×10^9／L；术中、术后未发生严重输血相关性不良反应。结论在地震伤员的救治中，常使用晶体液、胶体液补充有效循环血容量后，再根据可靠的血液指标，输注血液制品（RBC、FFP以2：1的比例输注，按需输注血小板）。

The perioperative capacity therapy of serious patients injured by earthquakes

Objective To analyse the peroperative capacity therapy of serious injured patients （ASA3 - 5 ）caused by Wenchuan earthquakes which were operated in the West China Hospital from 12th May to 11 th June, to gather essential informations and precious experiences and to guide the perioperative capacity therapy of serious injury patients in futrue. Methods Gather the patients＇ transfusion records of the categories, volume and the time of transfusion. Record the change of the index of Hb, Hct and the count of Ph during preoperation. Results The West China Hospital treated serious injured patients 244 times. In operation we infused crystal fluid, colloid fluid and blood products to supplement effective circulating blood volume, transfused blood products 167 times,total transfusion volume were 118500ml , the red blood cell （ RBC ） account for 67. 68%, fresh frozen plasma （FFP） occupies 32.32%. After operation there were 55 patients＇（ accounts for 32. 8% ）Hb,Hct,Plt dropped after operation,Hb dropped from 78 - 142g/L to 56 - 108g/L,Hct dropped from 25% -38% to 15% -25%, ,Ph dropped from （ 186 -256）×10^9/L to （73 - 129）×10^9L. And 102 patients＇（ accounts for 61.1% ） Hb,Hct,Ph were increased, Hb increased from 47 - 97g/L to 88 - 145g/L,Hct increased from 18% -29% to 26% -41% ,Ph increased from （66 - 123） ×10^9/L to （ 118 -263）×10^9/L. In perioperative no serious tranfusion complications were founded . Conclusion During the treatment of earthquake serious injured patients, after using crystal fluid and the colloid fluid to supplement effective circulating blood volume. The blood transfusion should according to the reliable hematology index （ The transfusion volume of RBC, FFP are 2 ： 1, the transfusion of blood platelet on demand）.