失血性休克限制性液体复苏的疗效评价

Healing effect of limited fluid resuscitation treatments on hemorrhagic traumatic shock

目的探讨限制性液体复苏方法对创伤性失血性休克病人的治疗结果，以提高治愈率。方法40例创伤性失血性休克病人随机分成常规液体复苏（常规）组（21例）、限制性液体复苏（限制）组（19例）。常规组在止血前早期、快速、足量补液，维持收缩压≥90mmHg（1mmHg：0．133kPa），限制组在止血前限制液体输入，维持平均动脉压（MAP）在6．65kPa，止血后输血输液。止血后两组维持MAP在9．31～10．64kPa。比较两组患者的平均输液量、治愈率。结果常规组死亡3例，治愈率85．7％；限制组无死亡，治愈率100％。两组治愈率比较差异有统计学意义（P〈0．05）。平均输液量常规组为（2950±525）ml，限制组为（2050±360）ml，两组比较差异有统计学意义（P〈0．05）。结论限制性液体复苏能避免过分扰乱机体的代偿机制和内环境，改善脏器灌注和氧供，显著降低了创伤性失血性休克病人的早期和后期病死率，改善预后。

Objective To evaluate the effect of limited fluid resuscitation treatments on the hemorrhagic traumatic shock in order to improve the cure rate. Methods Forty cases of the hemorrhagic traumatic shock patient were randomly divided into the regular fluid resuscitation group （ n = 21, regular group） and the limited fluid resuscitation group （n = 19, limited group）. In regular group, fast infusion of the full quantity fluid underwent in the early stage before hemostasia, keeping systolic blood pressure ≥90 mm Fig 1mmHg= 0. 133 kPa. In limited group, infusion of fluid was limited before hemostasia, keeping average MAP at 6.65 kPa, then bloo transfuse and fluid infusion underwent after hemostasia. After hemostasia, two groups kept MAP at 9.31-10.64 kPa. Results Three cases died in regular group, and the cure rate was 85.7%. No death in limit group, and the cure rate was 100%. There was significance difference between two groups （ P 〈 0.05 ）. Average transfusion quantities were （2950 ± 525） ml in regular group and （2050 ± 360） rnl in limited group, there was a significance difference between two groups （P 〈 0.05）. Conclusion The limited fluid resuscitation can avoid harassing organism compensation and internal environment, improving the organs filling and oxygen supplies, remarkably reducing the mortality and prognosis in the patients with hemorrhagic traumatic shock.