创伤失血性休克的液体复苏

Limited fluid resuscitation after uncontrolled hemorrhagic traumatic shock

目的探讨未控制出血的创伤失血性休克(hemorrhagic traumatic shock,HTS)的液体复苏治疗方法。方法回顾性分析我院536例未控制出血的HTS患者的液体复苏方法,比较常规液体复苏组和限制性液体复苏组以及7.5%高渗氯化钠组和林格氏液组的治愈率、多器官功能衰竭(MODS)、急性呼吸窘迫综合征(ARDS)的发生率及死亡率。结果常规液体复苏组治愈率为63.5%,死亡率为36.5%,ARDS发生率为23.8%,MODS发生率为35.1%;限制性液体复苏组治愈率为82.7%,死亡率为17.3%,ARDS发生率为8.7%,MODS发生率为16.5%。组间比较均有统计学意义(P<0.05)。7.5%高渗氯化钠组治愈率为86.6%,死亡率为13.4%,ARDS发生率为3.1%,MODS发生率为9.4%;林格氏液组的治愈率为74.0%,死亡率为26.0%,ARDS发生率为14.2%,MODS发生率为23.6%。结论限制性液体复苏治疗,特别是7.5%高渗氯化钠更能减少未控制出血的HTS患者MODS和ARDS的发生率,提高其治愈率。

Objective To explore the effect of limited fluid resuscitation of uncontrolled hemorrhagic traumatic shock.Methods 536 cases were retrospectively analyzed.The healing rate incidence of MODS and ARDS and mortality rate between regular fluid resuscitation group and limited fluid resuscitation group,and between 7.5% hypertonic saline fluid resuscitation group and lacatate Ringer＇s fluid resuscitation group were compared.Results Survival rate of regular fluid resuscitation group was 63.5%,mortality rate was 36.5%,incidence of MODS was 35.1%,incidence of ARDS was 23.8%.Survival rate of limited fluid resuscitation group was 82.7%,mortality rate was 17.3%,incidence of MODS was 16.5%,incidence of ARDS was 8.7%.There was statistical significance between two groups（P〈0.05）.Survival rate of 7.5% hypertonic saline fluid resuscitation group was 86.6%,mortality rate was 13.4%,incidence of MODS was 9.4%,incidence of ARDS was 3.1%,survival rate of lacatate Ringer＇s fluid resuscitation group was 74.0%,mortality rate was 26.0%,incidence of MODS was 23.6%,incidence of ARDS was 14.2%.There was statistical significance between two groups（P〈0.05）.Conclusion Limited fluid resuscitation especially 7.5% hypertonic saline fluid resuscitation is more rational to improve the prognosis of patients with uncontrolled traumatic shock than regular fluid resuscitation.