限制性液体复苏在创伤出血性休克中的应用价值

Study of limited fluid resuscitation in the treatment of hemorrhagic traumatic shock

目的研究限制性液体复苏在创伤出血性休克急救中的实用价值。方法选择创伤出血性休克患者出血未控制前行充分液体复苏90例为对照组,创伤出血性休克出血未控制前行限制性液体复苏患者86例为研究组。记录入院到出血未控制前的病死率、出血控制后24h的病死率及总病死率,记录并发症发生率,并随访患者直至出院或死亡。结果研究组入院到出血未控制前死亡2例（2.33%）;出血控制后24h死亡3例（3.49%）;总死亡7例（8.14%）。术后DIC7例、多器官功能衰竭（MODS）1例,并发症发生率9.30%。对照组入院到出血未控制前死亡6例（6.67%）;出血控制后24h死亡4例（4.44%）;总死亡13例（14.44%）。术后并发症急性呼吸窘迫综合征（ARDS）1例、DIC8例、MODS2例、脓毒血症2例,共13例,发生率14.44%。研究组入院到出血未控制前的病死率、出血控制后24h的病死率及总病死率均低于对照组（P〈0.05）,研究组并发症发生率低于对照组（P〈0.05）。结论限制性液体复苏能降低创伤失血性休克的病死率及并发症发生率,在创伤出血性休克的急救中具有实际应用价值。

Objective To study the value of limited fluid resuscitation in treating hemorrhagic traumatic shock. Methods The patients treated with enough fluid resuscitation were taken as control group （ n = 90 ）, while the patients treated with limited fluid resuscitation were taken as study group（ n =86）. All patients were followed up either to discharge or death. The death rate of patients before hemorrhage was controlled, the death rate of patients 24 hours after hemorrhage was controlled and overall death rate, incidence rate of complication were also recorded. Results The death rate of patients before hemorrhage was controlled was 2.33 % vs. 6.67 %, the death rate of patients 24 hours after hemorrhage was controlled was 3.49% vs. 4.44%, with the overall death rate of 8.14% vs. 14.44% in study group vs. control group. The death rates of patients in study group were lower than those of control group（ P 〈 0. 05 ）. The incidence rate of complication in study group was lower than that of control group （P 〈 0.05 ）. Postoperative DIC and MODS of study group occurred in 8 cases and 2 case, with the incidence rat of complication of 9.30% , while in control group I case developed ARDS, 8 experienced DIC, 2 occurred with MODS and 2 happened to be with pyemia, with the incidence rate of complication of 14.44%. Conclusion Limited fluid resuscitation has clinical useful value in emergency treatment of uncontrolled hemorrhagic traumatic shock, and it can reduce the mortality and complications of hemorrhagic traumatic shock.