创伤性休克术前限制性液体复苏的研究

Effect of preoperative limited fluid resuscitation to the patients with traumatic shock

目的研究创伤性休克术前进行限制性液体复苏的作用。方法对我院2002年1月～2005年10月期间收治的89例多发伤合并休克的患者，根据术前液体复苏控制的血压水平随机分为3组，A组和B组的收缩压分别维持在70和80mmHg左右，C组的收缩压维持在90mmHg以上。用损伤严重度评分（ISS）评价各组创伤严重程度可比性的前提下，比较各组的液体摄入量、术前血红蛋白含量、住院期间ARDS、ARF的发生率和总死亡率。结果（1）各组年龄、性别、损伤及休克程度，复苏开始时间和手术开始时间均无显著性差异。术前A、B和C三组之间的总输液量均有显著性差异，分别为（1687＋96）ml、（2096＋87）ml、（2976＋93）ml（P〈0．05）；并且三组之间浓缩红细胞的输入量也有显著性差异，分别为（294＋110）ml、（404±113）ml、（798＋230）ml（P〈0．05）。（2）C组患者术前血红蛋白含量【（94±45）g伽明显低于A组【（110＋22）g／L]和B组【（103＋24）g／L]（P〈0．05），但A、B组之间无显著性差异（P〉0．05）。（3）三组中急性肾功能衰竭（ARF）发生率无显著性差异（P〉0．05），但急性呼吸窘迫综合征（ARDS）的发生率在C组中（31．2％）明显高于A组（16．7％）和B组（18．2％）（P〈0．05），A组和B组之间ARDS的发生率无显著性差异（P〉0．05）。C组的病死率（34．4％）明显高于A组（12．5％）和B组（12．1％）（P〈0．05），但A组和B组之间的病死率无显著性差异（P〉0．05）。结论本研究结果表明，在创伤性休克术前未控制性出血条件下，限制性液体复苏可明显降低患者的出血量，ARDS的发生率和死亡率。

Objective To investigate the effect of preoperative limited fluid resuscitation to the patients with traumatic shock. Methods Eighty-nine patients with multiple injuries complicating with shock were treated in Changhai Hospital between Jan 2002 to Oct 2005 and were randomly divided into 3 groups according to the level of systolic blood pressure （SBP） at preoperative stage： the SBP of Group A and Group B was about 70 and 80 mm Hg, respectively; the SBP of Group C was over 90 mm Hg. Results （1）There was no significant difference in age, gender, injury severity score （ISS）, initiated resuscitation time and initiated operation time among three groups. Before surgery, there was significant difference in the amount of fluid resuscitation and also in the amount of infused erythrocyte suspension among Group A, B and C[ （1 687±96） ml, （2 096±87） ml, （2 976±93） ml, respectively, P〈0.05; and （294±110） ml, （404± 113） ml, （798±230） ml, respectively, P〈0.05）]. （2）The hemoglobin level in Group C [（94±45） g/L] was lower than that in Group A [（110±22） g/L ]and Group B [（103±24） g/L] （P〈0.05）. But there was no significant difference in the level of hemoglobin between Group A and B. （3）There was no significant difference in the incidence of acute renal failure （ARF） among three groups. The incidence of acute respiratory distress syn- drome （ARDS） of Group C （31.2%） was higher than 0.05）. The mortality of Group C （34.4%） was higher that of Group A （16.7%） and Group B （18.2%） （P〈 than that of Group A （12.5%） and Group B （12.1%） （P〈0.05）. Conclusion The results of our study show that the preoperative limited resuscitation in the patients with traumatic shock can reduce the amount of bleeding, incidence of ARDS and mortality.