急诊期未控制失血性休克小容量复苏效应的临床探讨

Clinical evaluation of the effect of small volume resuscitation on uncontrolled hemorrhagic shock at the acute stage

目的探讨急诊期小容量复苏对未控制失血性休克的复苏效应。方法回顾分析40例急诊创伤性未控制失血性休克患者复苏中使用过高渗高张溶液（小容量复苏组，n=20）和使用羟乙基淀粉、平衡盐溶液（常规液复苏组，n=20）的治疗情况，比较血流动力学、凝血功能、血红蛋白（HB）、血细胞比容（HCT）的变化及平均输液量。结果两组复苏均改善了血流动力学指标，小容量复苏组平均动脉压（MAP）上升速度、幅度、维持时间及休克指数下降程度大于常规液复苏组；两组复苏60min时HB、HCT下降，凝血酶原时间（PT）、部分凝血活酶时间（APTF）时间延长，小容量复苏组的改变明显小于常规液复苏组；观察期间小容量复苏组平均输液量明显少于常规液复苏组。结论急诊期小容量复苏对未控制失血性休克复苏效率高，有利于限制输液量，减少内环境和凝血功能的变化。

Objective To explore the effect of small volume resuscitation on uncontrolled hemorrhagic shock at the acute stage. Methods Forty traumatic patients with uncontrolled hemorrhagic shock at the acute stage were treated with either hypertonic/hyperosmotic fluid （ small volume group, n = 20 ） or hydroxyethyl starch （ HES ） and Lactated Ringer＇s solution （ routine fluid group, n = 20 ）. By examining the changes of hemodynamics, coagulation function, hemoglobin （ HB ）, haematocrit （ HCT ） and average infusion amounts, the curative effects were analyzed retrospectively. Results After the resuscitation, the hemodynamics was improved in both groups. In small volume group, the MAP increased more quickly and the effect lasted longer, and shock index decreased more significantly. At the 60min of resuscitation, HB and HCT decreased while PT and APTT prolonged in both groups, but the change was fewer significantly in the small volume group. In addition, less average infusion amount was given to small volume group. Conclusion Small volume resuscitation for uncontrolled hemorrhagic shock at the acute stage is more helpful to limited infusion amounts and fewer changes in both internal environment and coagulation function.