限制性液体复苏在产科失血性休克急诊救治中的临床研究

Clinical study of limited fluid resuscitation in emergency treatment of hemorrhagic shock in obstetrics department

目的研究限制性液体复苏在产科失血性休克患者急诊救治中的应用。方法选择2015年5月至2018年5月在本科室就诊分娩的失血性休克患者80例,根据救治方法的不同,分为A组和B组,每组40例,A组采用限制性液体复苏治疗,B组采用常规液体复苏治疗。比较两组治疗效果,观察不同液体复苏方法对剩余碱、血乳酸、凝血功能、红细胞比容(hematocrit,HCT)、输液量及并发症的影响。结果A组复苏成功1 h后凝血酶原时间[(13.2±8.5)s]比B组凝血酶原时间[(15.4±8.7)s]短,差异有统计学意义(P<0.05);A组复苏成功后1 h红细胞比容(0.335±0.007)高于B组(0.289±0.007),差异有统计学意义(P<0.05);A组复苏成功1h后剩余碱[(-5.30±0.51)mmol/L]高于B组[(-9.72±0.62)mmol/L],差异有统计学意义(P<0.05);A组复苏成功后1 h乳酸[(2.60±0.51)mmol/L]低于B组[(3.30±0.46)mmol/L],差异有统计学意义(P<0.05);比较两组复苏总输液量,A组总输液量[(1028±320)ml]少于B组总输液量[(2135±261)ml],差异有统计学意义(P<0.05);A组急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)及多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)并发症发生率(10%,10%)低于B组(30%,25%),其差异有统计学意义(P<0.05);A组治愈率(83%)高于B组(30%),差异有统计学意义(P<0.05)。结论限制性液体复苏可有效维持重要器官血流灌注,降低产科失血性休克并发症的发生率。

Objective To study the application of limited fluid resuscitation in emergency treatment of patients with hemorrhagic shock in obstetrics.Methods Eighty patients with hemorrhagic shock who were diagnosed and treated in our hospital from May 2015 to May 2018 were selected.According to different treatment methods,the patients were divided into group A and group B with 40 cases in each group.The patients in group A received limited fluid resuscitation,and the patients in group B received routine active fluid-related resuscitation.Then we analyzed and compared the effects of these two different methods on base excess,blood lactic acid,coagulation functions,hematocrit(HCT),infusion volume and complications between the two groups.Results After one-hour treatment,the prothrombin time(PT)in group A[(13.2±8.5)s]was shorter than that in the group B[(15.4±8.7)s];HCT(0.335±0.007)was higher than that in the group B(0.289±0.007);The base excess(BE)[(-5.30±0.51)mmol/L]was higher than that in the group B[(-9.72±0.62)mmol/L];The blood lactic acid(BLA)in the group A[(2.60±0.51)mmol/L]is lower than that in the group B[(3.30±0.46)mmol/L].The fluid input in the group A[(1028±320)ml]is lower than that in the group B[(2135±261)ml].The occurrence of the post-operative complications such as acute respiratory distress syndrome(ARDS)and multiple organ dysfunction syndrome(MODS)in the group A is less than those in the group B(10%,10%v.s.30%,25%).The differences were statistically significant(P<0.05).Conclusion Restricted fluid resuscitation can effectively maintain the perfusion of vital organs and reduce the incidence of hemorrhagic shock complications in obstetrics.