限制性液体复苏在治疗晚期血吸虫病上消化道大出血中的临床应用研究

目的：探讨不同的液体复苏对晚期血吸虫病上消化道大出血低血容量性休克的应用效果。方法：将313例晚期血吸虫病上消化道大出血低血容量性休克患者,随机分成充分液体复苏组（153例）和限制液体复苏组（160例）,比较其凝血功能,并发症发生率、病死率已及住院天数。结果：2h内充分液体复苏组病死率37.9%,限制液体复苏组病死率25%,两组2h病死率和住院天数比较差异有统计学意义（P〈0.01）,充分液体复苏组血浆凝血酶原时间延长,血小板呈进行性下降,存活患者并发症的发生率显著高于限制性液体复苏组（P〈0.01）。限制液体复苏组存活患者住院天数明显缩短（P〈0.01）。结论：限制性液体复苏能降低晚期血吸虫病上消化道大出血低血容量性休克患者病死率,提高生存率,同时降低并发症的发生率,减少住院天数,改善预后。

The clinical application research about fluid resuscitation in the treatment of advanced schistosomiasis patients with upper gastrointestinal bleeding

Objective： To investigate the effect of different fluid resuscitation in the treatment of advanced schistosomiasis patients with upper gastrointestinal bleeding and hypovolemic shock. Method： 313 advanced schisto- somiasis patients with upper gastrointestinal bleeding and hypovolemic shock were randomly divided into two groups：adequate fluid resuscitation group （153 samples） and limited fluid resuscitation group （160 samples）. Co- agulation, the incidence of complications, mortality and hospitalization days were analyzed and compared between the two groups. Result：The mortality of adequate fluid resuscitation group was 37.9% in 2 hours,and the mortali- ty of limited fluid resuscitation group was 25%. Difference of the mortality in 2 hours between the two groups was significant （P〈0.01）. The Prothrombin time prolonged, platelet counts decreased and the incidence of complica- tions was significantly higher in adequate fluid resuscitation group than those in the limited fluid resuscitation group. The number of days of hospitalization in survival patients was significantly shorter in the limited fluid resus- citation group （P〈0.01）. Conclusion： Limited fluid resuscitation can reduce the mortality of gastrointestinal bleed- ing patients with hypovolemie shock. The incidence of complications can be induced,the length of hospital stay can be reduced, and the prognosis of advanced schistosomiasis can be improved.