创伤失血性休克急救中限制性液体复苏的临床价值

目的探讨与分析限制性液体复苏在创伤性休克术前急救中的临床价值。方法选择北京燕化医院急诊科2009年3月-2011年12月急诊救治98例严重多发伤合并失血性休克患者,随机分为A组（n=50）和B组（n=48）。在创伤失血性休克术前急救中将两组收缩压分别维持在10-12 kPa（75-90 mm Hg,1 mm Hg=0.133 kPa）（A组）和12 kPa以上（〉90 mm Hg）（B组）。比较两组损伤严重度评分（ISS）、液体输入量、输血量、血红蛋白含量、血小板计数、中性粒细胞计数、血浆渗透压、pH值、碱剩余（BE）、国际化标准比例（INR）、纤维蛋白原、电解质及住院期间急性呼吸窘迫综合征（ARDS）、急性肾功能衰竭（ARF）、全身炎症反应综合征（SIRS）的发生率和病死率。结果①两组总输液量、浓缩红细胞输入量、血红蛋白量、血小板及中性粒细胞数差异均有统计学意义（P〈0.05）。②两组pH值、BE差异无统计学意义（P〉0.05）;而血浆渗透压、INR、纤维蛋白原及电解质差异均有统计学意义（P〈0.05）。③住院期间两组ARF发生率差异无统计学意义（P〉0.05）;但ARDS、SIRS的发生率及病死率B组明显高于A组,差异有统计学意义（P〈0.05）。结论术前限制性液体复苏可明显减少出血量,节约血源,同时减少了再次出血及缺血再灌注损伤,降低了ARDS、SIRS等的发生率和病死率。

Clinical value of restrictive fluid resuscitation in first aid of traumatic hemorrhagic shock

Objective To discuss and analyze the clinical value of restrictive liquid recovery in traumatic shock emer gency treatment.Methods 98 cases of patients with severe multiple trauma combined with uncontrolled hemorrhagic shock given emergency treatment in Department of Emergency,Beijing Yanhua Hospital from March 2009 to Decem ber 2011 were selected,and randomly divided into group A（n = 50） and group B（n = 48）.Systolic blood pressure of two groups during first aid of traumatic hemorrhagic shock were kept at 10-12 kPa（75-90 mm Hg,1 mm Hg=0.133 kPa,group A） and 12 kPa above（more than 90 mm Hg,group B） respectively.Injury severity score（ISS）,input of fluid,blood transfusion amount,hemoglobin levels,platelet count,neutrophil count,plasma osmotic pressure,pH value,residual alkali（BE）,international standard ratio（INR）,fibrinogen,electrolyte,the occurrence of hospital acute respira tory distress syndrome（ARDS）,acute renal failure（ARF）,systemic inflammatory response syndrome（SIRS） and mor tality were compared between the two groups.Results ① Total infusion volume,packed red blood cells enter the amount,the amount of hemoglobin,platelet and neutrophil between the two groups had significant difference（P〈0.05）.②Two indicates of pH value,BE had no significant difference between the two groups（P〈0.05）;plasma osmolality,INR,fibrinogen and electrolyte had significant differences（P〈0.05）.③During hospitalization,incidence of ARF in the two groups had no significant difference（P〈0.05）;incidence of ARDS and SIRS and mortality in group B were significantly higher than those in group A,there were significant differences（P〈0.05）.Conclusion The preoperative fluid resuscitation can significantly reduce the amount of bleeding and save the blood source;while reduce re-bleed ing and ischemia-reperfusion injury,reduce incidence of ARDS,SIRS and mortality.