限制性液体复苏在产科大出血急诊救治中的应用效果

Application effect of restrictive fluid resuscitation in emergency treatment of obstetric massive hemorrhage

目的探讨限制性液体复苏在产科大出血急诊救治中的应用效果。方法选取2018年5月至2020年12月深圳市宝安区妇幼保健院产科医院收治的200例产科大出血患者作为研究对象,采用随机抽签法分为观察组(100例)与对照组(100例)。观察组采用限制性液体复苏,对照组采用传统输液法复苏。比较两组液体输入量、出血量和输血量、血流动力学指标、凝血功能指标、治疗效果。结果治疗2 h后观察组液体输入量、出血量、输血量均少于对照组,差异有统计学意义(P<0.05)。两组治疗前的平均动脉压(MAP)、中心静脉压(CVP)、血细胞比容(HCT)、心率(HR)比较,差异无统计学意义(P>0.05),两组治疗后的MAP、CVP、HCT均高于治疗前、HR低于治疗前,且观察组患者治疗后MAP、CVP、HCT均高于对照组,HR低于对照组,差异有统计学意义(P<0.05)。两组治疗前的凝血酶原时间(PT)、部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)比较,差异无统计学意义(P>0.05)。治疗后两组的PT、APTT、TT均低于治疗前、FIB高于治疗前,且观察组治疗后PT、APTT、TT均低于对照组、FIB高于对照组,差异有统计学意义(P<0.05)。观察组患者治疗总有效率高于对照组,差异有统计学意义(P<0.05)。结论限制性液体复苏在产科大出血急诊救治中效果十分显著,能够有效改善液体输入量、出血量和输血量、血流动力学指标、凝血功能指标、治疗效果。

Objective To explore the application effect of restrictive fluid resuscitation in the emergency treatment of obstetric hemorrhage.Methods From May 2018 to December 2020,200 patients with obstetric hemorrhage admitted to Shenzhen Bao′an District Maternal and Child Health Hospital were selected as the research objects,and divided into observation group(100 cases)and control group(100 cases)by random lottery method.The observation group was treated with restrictive fluid resuscitation,and the control group was treated with traditional infusion resuscitation.The fluid input volume,bleeding volume and blood transfusion volume,hemodynamic indicators,coagulation function indicators,and treatment effect were compared between the two groups.Results After 2 hours of treatment,the amount of fluid input,blood loss and blood transfusion in the observation group were less than those in the control group,and the differences were statistically significant(P<0.05).There were no statistically significant differences in mean arterial pressure(MAP),central venous pressure(CVP),hematocrit(HCT),and heart rate(HR)between the two groups before treatment(P>0.05).After treatment,MAP,CVP and HCT of the two groups were higher than those before treatment,and HR was lower than that before treatment,and MAP,CVP and HCT of observation group were higher than those of control group,and HR was lower than that of control group,the differences were statistically significant(P<0.05).There were no significant differences in prothrombin time(PT),partial thrombin time(APTT),thrombin time(TT)and fibrinogen(FIB)between the two groups before treatment(P>0.05).After treatment,PT,APTT and TT in the two groups were lower than those before treatment,while FIB was higher than that before treatment,and PT,APTT and TT in the observation group were lower than those of control group,while FIB was higher than that of control group,the differences were statistically significant (P<0.05). The total effective rate of observation group was higher than that of control group, the difference was statistically significant (P<0.05). Conclusion Restricted fluid resuscitation is very effective in emergency treatment of obstetric massive hemorrhage, which can effectively improve fluid input, blood loss and transfusion volume, hemodynamic indexes, coagulation function indexes and therapeutic effect.