限制性液体复苏对创伤失血性休克患者发生SIRS的影响

目的:研究限制性液体复苏对创伤失血性休克患者炎性因子以及产生全身炎症反应综合征(SIRS)的影响。方法:选择180例创伤失血性休克患者随机分为快速大量液体复苏组(A组,n=90)和限制性液体复苏组(B组,n=90),另选择30例正常人作为对照组(C组)。A组出血未控制前进行快速大量的液体复苏,B组在出血未控制前行限制性液体复苏,1h后均接受手术止血治疗。观察患者外周血中TNF-α、IL-1β、IL-6以及IL-10等炎性因子等水平的变化以及SIRS的发病率。结果:四种不同的炎性因子变化趋势基本一致,快速大量液体复苏组与限制性液体复苏组外周血中的TNF-α、IL-1β、IL-6以及IL-10水平在任何时间点均高于正常人群组,两组随着创伤时间的延长TNF-α、IL-1β、IL-6以及IL-10水平都有逐渐上升的趋势,但在创伤后120min及创伤后240min快速大量液体复苏组外周血中的TNF-α、IL-1β、IL-6以及IL-10水平明显高于限制性液体复苏组(P<0.05);A组出现SIRS62例(68.9%),B组出现SIRS38例(42.2%),B组SIRS的发病率显著低于A组。结论:限制性液体复苏可以有效抑制创伤失血性休克患者炎性因子的过度释放,对创伤失血性休克患者发生SIRS有明显的抑制作用。

The Effects of Limited Fluid Resuscitation on Inflammatory Factor and SIRS Occurrence in Patients with Trauma Hemorrhage Shock

Objective To investigate the effects of limited fluid resuscitation on inflammatory factor and SIRS occurrence in patients with trauma hemorrhage shock.Methods 180 patients with trauma hemorrhagic shock were randomly divided into limited fluid resuscitation group（n=90） and large quantity fluid rapid resuscitation group（n=90）,additionly,30 healthy volunteers as healthy volunteers group（n=30）.The levels of TNF-α ,IL-1β ,IL-6 and IL-10 were assessed with enzyme-linked immunosorbent assay （ELISA）.Investigate the SIRS morbility of all the patients.Results Compared with the healthy volunteers group,the levels of TNF-α ,IL-1β ,IL-6 and IL-10 were significantly increased in limited fluid resuscitation group and large quantity fluid rapid resuscitation group.The levels of TNF-α,IL-1β ,IL-6 and IL-10 were all increased progressively with time passed in limited fluid resuscitation group and large quantity fluid rapid resuscitation group,but the levels of TNF-α,IL-1β ,IL-6 and IL-10 in large quantity fluid rapid resuscitation group were markedly higher than limited fluid resuscitation group at the time point of 120 min and 240 min after in-hospital;the SIRS morbility of A group is 68.9% and the mobility of B group is 42.2%,the SIRS morbility of B group is markedly lower than that in A group.Conclusion Limited fluid resuscitation can inhibit the over-release of inflammatory factor in patients with trauma hemorrhage shock effectively.It can hold-back the proceeding of SIRS effectively.