不同晶胶比液体复苏对失血性休克的影响

目的比较失血性休克中不同晶胶比液体复苏的优劣,从而选择合适的晶胶比例。方法将29例失血性休克患者分为高晶胶比组(13例)和低晶胶比组(16例),观察ICU住院日、复苏液体量、复苏前及复苏达标后即时、24h、48h血流动力学参数、血管外肺水指数(EVLWI)、心室脑钠肽(BNP)、氧合指数(PO2/FiO2)及血乳酸。结果两组心指数(CI)、全心舒张末期容积(GEDVI)、平均动脉压(MAP)在复苏后均改善,复苏达标后即时、24h、48h两组CI、GEDVI、MAP比较,差异均无统计学意义(t分别=0.09、0.56、0.17;1.18、0.17、0.82;1.25、1.35、0.42,P均>0.05);两组EVLWI、BNP、PO2/FiO2比较,差异均有统计学意义(t分别=3.70、2.57、4.43;2.39、3.53、3.74;4.12、2.77、3.11,P均<0.05);复苏达标后即时、24h低晶胶比组血乳酸均低于高晶胶比组,差异均有统计学意义(t分别=2.23、3.78,P均<0.05);两组液体量、ICU住院日比较,差异有统计学意义(t分别=5.12、4.61,P均<0.05)。结论失血性休克宜采取低晶胶比液体复苏。

Effects of fluid resuscitation with different crystalloid-colloid ratio on haemorrhagic shock

Objective To investigate the effects of fluid resuscitation with different crystalloid-colloid ratio on patients with haemorrhagic shock. Methods Twenty nine patients with haemorrhagic shock were divided into high Crystalloid-col- loid ratio group（n=13） and low crystalloid-colloid ratio group（n=16）. Length of ICU stay, fluid intake in the fluid resusci- tation, hemodynamic parameters, extravascular lung water index （EVLWI）, serum brain natriuretic peptide （BNP）, oxy- genation index （POJFiO2） and blood lactic acid were observed before fluid resuscitation and 0,24,48 hours after resuscita- tion success. Results Cardic index （CI）, global end-diastolic volume index （GEDVI） and mean artery blood pressure （MAP） were all improved after resuscitation success, but at 0,24,48 hours after resuscitation success, those of the two groups were not statistically significant （t=0.09,0.56,0.17;1.18,0.17,0.82; 1.25,1.35,0.42,P〉0.05）. The differences of EVLWI, BNP and POJFiO2 between the two groups were statistically significant （t =3.70,2.57,4.43 ;2.39,3.53,3.74; 4.12,2.77,3.11, P〈0.05）. The level of Blood lactic acid of low crystalloid-colloid ratio group was lower than that of the high crystalloid-colloid ratio group at 0,24 hours after resuscitation （t=2.23,3.78,P〈0.05）. The differences of fluid intake and length of ICU stay between the two groups were statistically significant（t=4.61,5.12,P〈0.05）. Conclusions It should adopted low crystalloid-colloid ratio of fluid resuscitation on haemorrhagic shock.