多发伤并休克的急救液体复苏策略

The Strategy of Intravenous Transfusion Resuscitation for Emergency Treatment in Patients with Multiple Injury Complicated with Shock

目的:探讨多发伤并休克急救中的液体复苏策略。方法:对86例多发伤合并休克患者进行分组。A组28例,为控制性出血患者行积极液体复苏策略。B组58例,为非控制性出血患者,随机分为B1、B2两亚组。其中B1亚组37例行限制复苏策略,及时行控制性手术,术后再行积极复苏。B2亚组19例,行积极复苏后手术治疗。分别统计其心率(HR)、平均动脉压(MAP)、心脏指数(CI),开始手术时间,术后休克纠正天数,并发症发生率,病死率等指标进行比较分析。结果:A组2h后血流动力学指标明显改善。术后休克纠正时间短,并发症发生率,病死率较低。B组限制复苏明显优于积极复苏。结论:对于多发伤合并休克患者,急救液体复苏时,要首先判断休克是控制性出血还是非控制性出血休克,不同的情况要采取不同的液体复苏策略。

Objective： To investigate the strategy of intravenous transfusion （IVT） resuscitation for emergency treatment in patients with multiple injury complicated with shock. Methods：86 patients with multipie injury complicated with shock were randomly divided into two groups - A and B. 28 patients with controlled bleeding were treated by active IVT for resuscitation in group A. 58 patients with uncontrolled bleeding in group B were divided into two subsets -B1 and B2.37 patients of group BI were treated by operation for emergency treatment and given the limited resuscitation after the operation ; 19 patients of group B2 were given active resuscitation before the operation. All the patients were analyzed in the indexes of heart rate （ HK ）, mean arterial pressure （ MAP）, cardiac index （ CI ）, the time of the beginning of the operation, the average time of shock recovered after operation, case fatality rate, incidence of complication, etc. Result： The hemodynamics of the patients in group A were improved obviously after two hours of resuscitation. The patients of group B treated by delayed resuscitation were more effective than the active ones. Conclusion：h is important to diagnose the shock caused by controlled or uncontrolled bleeding and whether complicated serious lung and brain injuries when we treat them by IVT resuscitation. The different IVT resuscitation strategies are carried on according to the different conditions.