两种液体复苏方法在创伤失血性休克患者中的应用研究

【目的】比较延迟液体复苏和即刻液体复苏对创伤失血性休克（HTS）患者的救治效果。【方法】回顾性分析2006年5月-2011年10月我院急诊经院前急救收治的63例有HTS患者，根据患者人院前纠正平均动脉压（MAP）水平分为即刻液体复苏组（A组，MAP90～110mmHg，32例）和延迟液体复苏组（B组，MAP70—89mmHg，31例），对两组患者复苏前后的3个时间节点检测血红蛋白（Hh）、红细胞压积（Hct）、血小板（Pit）、碱缺失（BE）、动脉血PH（BpH）、谷丙转氨酶（ALT），统计两组患者输入液体量、MAP、并发症发生率及死亡率。【结果】两组在建立静脉通路前（即液体复苏前）Hb、Hct、Plt、BE、BpH、AIJT比较无统计学差异（P〉0．05）。在院前急救期，A组较B组Hb、Hct、Ph、BE、BpH均下降，有统计学意义（P〈0．05），在院内救治期，A组较B组Hb、Hct、Plt、BE、BpH均下降，差异有统计学意义（P〈0．05）。两组MAP在充分液体复苏前各自稳定在90～110mmHg和70～90mmHg，A组液体输入量（3250±457）ml，B组液体输入量（1080±514）ml，两组在MAP和输液量比较差异有统计学意义（P〈0．05），本研究发生并发症20例，死亡5例，两组患者并发症发生率和死亡率比较差异无统计学意义（P〉0．05）。【结论】对活动性出血的HTS患者院前延迟性液体复苏，维持适当的MAP水平，可在一定程度上改善休克期组织脏器的灌注和氧供。

Studies on the application of two methods of fluid resuscitation in trauma patients with hemorrhagic shock

Objective]To compare the effect of treating patient with delayed fluid resuscitation and immediate fluid resuscitation in trau- matic hemorrhagic shock（HTS）. Methods] A total of 63 patients with HTS admitted to our emergency department form 2006-05 to 2011-10 were reviewed. These cases were divided into two groups according to the levels of the mean arterial pressure（MAP） before hospi- tal ization： which were immediate fluid resuscitation group（Group A, MAP 90 - 110 mmHg, 32 cases） and delayed fluid resuscitation group （Group B, MAP 70 ~ 89 mmHg, 31 cases）. Hemoglobin（Hb）, hematocrit（Hct）, platelets（Plt）, base deficit（BE）, PH of arterial blood （BpH） and alanine aminotransferase（ALT） were tested at three resuscitation points of both groups. Input liquid, MAP, incidence of complica- tions and mortality after resuscitation were recorded. Results] The difference of Hb, Hct,, Pit, BE, BpH and ALT of the two groups was not statistically significant （P〉O.05） before the establishment of intravenous access fluid resuscitation. In pre-hospital phase, Hb, Hct Pit BE, and BpH of A group were fallen, while B Group were increased slightly（P〈0.05）. In hospital treatment phase, Hb, Hct, Pit, BE and BpH levels were increased in group B than Group A（P〈O.05）. Before full fluid resuscitation, MAP remained at 90-110 mmHg and 70-90 mmHg respectively, The input transfusion in A Group was （3 250 _＋ 457） ml, and B Group （1 080 _＋ 514） ml, The differences of the MAP and input were of statistical significance（P〈O.05）. In this study, complications occurred in 20 patients , and 5 patients died. The difference was statistically significant in the complication incidence and mortality between two groups（P〈O.05）. Conclusion]Delayed fluid resuscita- tion is a safer and more effective way for uncontrolled bleeding of patients with HTS, which contain recommending permissive MAP in pre- hospital. For it can improve organ perfusion and oxygen supply in sh~k stage to a certain degree.