三种液体复苏方法救治创伤性失血性休克的应用研究

Application of three fluid resuscitation methods to the treatment of hemorrhagic traumatic shock patients

目的探讨不同液体复苏方法对创伤性失血性休克(HTS)的救治效果。方法用不同液体复苏方法救治HTS患者73例,随机分为常规液体复苏组(27例)、限制性液体复苏组(25例)和高渗盐溶液复苏组(21例),对三组患者复苏前后的血流动力学指标、输入液体量、血清乳酸值、血气碱剩余值进行统计学分析。结果常规组液体输入量为(3012±497)mL,限制组液体输入量为(2156±541)mL,两组比较差异有统计学意义(P<0.05);高渗组液体输入量为(2235±503)mL,与常规组比较差异有统计学意义(P<0.05),与限制组比较差异无统计学意义(P>0.05)。限制组、高渗组与常规组复苏前血乳酸值、碱剩余值比较差异均无统计学意义(P>0.05),复苏12h及24h血乳酸、碱剩余检测值差异有统计学意义(P<0.05)。本研究治愈61例(83.6%),死亡12例(16.4%),发生ARDS11例,MODS15例。三组患者治愈率、死亡率、ARDS发生率、MODS发生率比较差异有统计学意义(P<0.05)。结论采用限制性液体复苏和高渗盐溶液复苏方法治疗HTS可明显增加有效循环血量,改善组织器官灌注,提高治愈率,降低死亡率,治疗效果均优于常规液体复苏方法。

Objective To discuss the different methods of fluid resuscitation for the treatment of hemorrhagic traumatic shock （ HTS ）. Methods 73 clinical records of hemorrhagic traumatic shock using different methods of fluid resuscitation in the emergency department of Tongren hospital from 2005 - 07 to 2007 - 11 were reviewed. These cases were randomly divided into three groups according to the methods of the resuscitation, which were the conventional resuscitation group （conventional group, 27cases ）, the limited fluid resuscitation group （limited group, 25cases ） and the hypertonic saline solution resuscitation group（hypertonic saline group, 21 cases）. The hemodynamic index, the input, the level of lactic acid and base excess before and after the resuscitation were analysed. Results The input in the conventional group was （3012 ± 497 ） mL, and the limited group was （2156 ± 541 ）mL. The difference of the input between two groups was significant （ P 〈 0.05 ）. The input of the hypertonic saline group was （ 2235 ± 503 ） mL. The difference of the input between the conventional group and the hypertonic saline group was significant （P 〈 0.05 ） , but there was no significant difference between the limited group and the hypertonic group （ P 〉 0.05 ）. There were no significant differences in the lactic acid and the base excess between the limited fluid resuscitation group, the hypertonic saline group ancl the conventional resuscitation group （P 〉 0.05 ）. The value of lactic acid in 12 hrs＇ resuscitation and 24 hrs＇resuscitation were significant, as well as the base excess. In this investigation, 61 patients （ 83. 6% ） were cured, and 12 patients （ 16.4% ） died. 11 patients were ARDS. 15 patients were MODS. The differences of the cure rate, mortality, ARDS incidence and MODS incidence among these three groups were significant （ P 〈 0.05 ）. Conclusions Limited fluid resuscitation and the hypertonic saline solution resuscitation for the treatment of hemorrhagic traumatic shock can increase the effective circulating blood volume and improve the perfusion of tissue and organ, which not only raise the cure rate, but also decrease the mortality. The curative effect of two methods is better than the method of the conventional resuscitation.