限制性液体复苏治疗34例创伤失血性休克患者的临床分析

目的 探讨限制性液体复苏治疗创伤性失血性休克患者的临床疗效。 方法 将68例创伤性休克患者采用随机数字法分为2组。对照组给予积极液体复苏，观察组给予限制性液体复苏。观察2组心率、平均动脉压、血氧饱和度、复苏液体使用量以及血红蛋白浓度、血清乳酸水平、凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、治愈率、病死率、并发症率。 结果 治疗后，2组平均动脉压、血氧饱和度水平显著升高(P＜0.05)，且观察组平均动脉压水平显著低于对照组(P＜0.05)，而血氧饱和度水平显著高于对照组(P＜0.05)。治疗后，2组心率水平显著降低(P＜0.05)，且观察组心率水平显著低于对照组(P＜0.05)。观察组复苏液体使用量以及血红蛋白浓度显著低于对照组(P＜0.05)。治疗后，2组血清乳酸水平显著降低(P＜0.05)，且观察组血清乳酸水平显著低于对照组(P＜0.05)。2组的凝血酶原时间、活化部分凝血酶时间水平显著升高(P＜0.05)，观察组的凝血酶原时间、活化部分凝血酶时间水平显著低于对照组(P＜0.05)。观察组治愈率为67.5%，显著高于对照组的26.5%(P＜0.05)。观察组病死率、并发症率为8.8%、23.5%，显著低于对照组的29.4%、47.1%(P＜0.05)。 结论 限制性液体复苏能稳定组织灌注压和外周循环，调动机体的凝血机制，提高患者生存率，降低病死率。 

Clinical analysis of 34 patients with traumatic hemorrhagic shock undergoing limited fluid resuscitation

Objective To investigate the clinical effect of limited fluid resuscitation in the treatment of traumatic hemorrhagic shock patients. Methods Total 68 traumatic patients with hemorrhagic shock were divided into 2 groups by random number method.The patients in the control group were given positive fluid resuscitation,while the patients in the observation group were given limited fluid resuscitation.The heart rate,mean arterial pressure,oxygen saturation,the used fluid resuscitation amount and hemoglobin concentration,serum lactate level,prothrombin time(PT),activated partial thromboplastin time(APTT) cure rate,mortality,morbidity of two groups were accounted. Results After the treatment,mean arterial pressure and oxygen saturation levels of both groups were significantly increased(P<0.05),mean arterial pressure of the observation group were significantly lower than that in the control group(P<0.05),and oxygen saturation levels of the observation group were significantly higher than that in the control group(P<0.05).After the treatment,heart rate of both groups was significantly reduced(P<0.05),heart rate of the observation group was significantly lower than that in control group(P<0.05).The fluid resuscitation amount hemoglobin concentration of the observation group were significantly lower than that in the control group(P<0.05).After the treatment,the levels of serum lactate levels were significantly lower(P<0.05),and serum lactate levels of the observation group was significantly lower than that in the control group(P<0.05);The prothrombin time(PT),activated partial thromboplastin time(APTT)levels of the two groups were significantly increased(P<0.05),PT and APTT of the observation group were significantly lower than that in the control group(P<0.05).The cure rate of the observation group was 67.5%,significantly higher than that in the control group 26.5%(P<0.05).The mortality rate and complication rate of the observation group were 8.82% and 23.5%,significantly lower than 26.5% and 47.1% in the control group(P<0.05). Conclusion Limited fluid resuscitation can stabilize the tissue perfusion pressure and peripheral circulation,mobilize clotting mechanism,improve patient survival,reduce mortality.