创伤性休克早期液体复苏策略对临床预后的影响

Effects of early fluid resuscitation strategy on clinical prognosis in traumatic shock patients

目的探讨2种不同液体复苏方法对创伤性休克早期复苏效果及对临床预后的影响。方法用2种不同复苏液体救治创伤性休克（HTS）患者126例。随机分为常规液体复苏组（66例）、高渗氯化钠羟乙基淀粉注射液复苏组（60例），对两组患者复苏前后的心率、血压、呼吸、血钠、血氯、凝血酶原时间以及收住专科后的并发症及转归进行观察，进行统计学分析。结果常规组液体输入量为（3000±500）mL，高渗液组为（2000±200）mL，2组比较差异有统计学意义（P〈0．05）；常规组与高渗液组用药前后30rain到1h的心率、血压、呼吸变化比较差异有统计学意义（P〈0.05）；2组用药前后30min到1h血钠、血氯、凝血酶原时间比较差异无统计学意义（P〉0．05）；两组患者从发病到收住专科后ARDS发生率、MODS发生率、治愈率、病死率比较差异有统计学意义（P〈0．05）。结论采用高渗氯化钠羟乙基淀粉注射液对创伤性休克早期进行液体复苏，液体用量小，可在短时间内提高血压、改善呼吸，为实施原发伤手术创造了有利条件，提高了抢救成功率，降低了并发症的发生，降低了病死率，值得临床推广应用。

Objective To discuss the effects of two different fluid resuscitation methods on early resuscitation and clinical prognosis in traumatic shock patients. Methods One hundred and twenty-six patients were treated with two different fluid resuscitation methods in traumatic shock （TS）. These patients were randomly divided into 2 groups according to the strategy： the conventional resuscitation group （conventional group, 66 cases）, the hypertonic saline solution resuscitation group （hypertonic saline group, 60 cases）. The heart rate, blood pressure, breath, blood Na^＋ , blood Cl^- , the original thrombin time before and after the resuscitation and the syndrome were observed and analyzed. Results The input in the conventional group was （ 3000 ±500） mL, in the hypertonic saline group was （2000 ±200） mL. The difference of the input between the two groups was significant （ P 〈 0. 05 ）. The difference of the heart rate, blood pressure, breath, and the original thrombin time before and after half hour to one hour of tbe resuscitation in the two groups was not significant （ P 〈 0. 05 ）. The difference of the blood NA^＋ , blood CL^- , and the original thrombin time before and after half hour to one hour of the resuscitation in the two groups was not significant （P 〈 0. 05 ）. The difference of the ARDS incidence, MODS incidence, cure rate and death rate from onset of the diseases to hospitalization in the two groups was significant （P 〈 0. 05）. Conclusions The fluid resuscitation strategy with hypertonic saline in early period of traumatic shock is efficient, which can work well with low fluid quantity, enhance blood pressure in short time, improve breath quality, save time for the operation of the primary injury, heighten the resuscitation rate, decrease the syndrome incidences and the death rate. The early fluid resuscitation strategy is worthy of clinical application and popularization.