限制性液体复苏救治创伤性失血性休克临床应用研究

Clinical application research of limited fluid resuscitation for traumatic hemorrhagic shock

目的探讨限制性液体复苏方法对创伤性失血性休克（HTS）的救治效果。方法用限制性液体复苏及常规液体复苏方法救治HTS患者68例，随机分为限制性液体复苏组（36例），常规液体复苏组（32例），对两组患者复苏前后血流动力学指标、输入液体量、血清乳酸值、血气碱剩余值进行统计学分析，并比较两组住院期间ARDS、ARF的发生率和死亡率。结果限制性液体复苏组液体输入量为（1966±348）ml，常规液体复苏组液体输入量为（3604±456）ml，两组比较差异有统计学意义（P〈0．05）；限制性液体复苏组、常规液体复苏组复苏前血乳酸值及碱剩余值比较差异无统计学意义（P〉0．05），复苏12、24h后血乳酸值及碱剩余值比较差异有统计学意义（P〈0．05）；本研究治愈57例（83．8％），死亡11例（16．2％），发生ARDS14例，ARF7例，二组治愈率、死亡率、ARDS发生率比较差异有统计学意义。结论本组研究表明：采用限制性液体复苏在救治创伤性失血性休克患者方面，能有效地改善组织器官血液灌注，提高治愈率，降低死亡率，治疗效果优于常规液体复苏方法。

Objective Aims To explore the effectiveness of limited fluid resuscitation method on traumatic hemorrhagic shock（HTS）. Methods 68 HTS patients was randomly grouped to 36 limited fluid resuscitation and 32 routine fluid resuscitation, statistic discrepancy comparation at pre-or post-resuscitation was based on several variables as hemodynamic measurements, fluid infusion intake, serum lactic acid,base excess on arterial blood gas. The incidence and mortality of acute respiratory distress syndorme （ ARDS ） and acute renal failure （ARF） in the two group were also comparative significantly. Results Fluid infusion intake of the limited fluid resuscitation group（ 1966 ± 348 ） was statistically less than that in routine group （3604± 456 ） （ P 〈 0. 05 ）. the value of serum lactic acid and base excess in the two group before treatment was not statistically signifieant（ P 〉 0. 05 ） , but with statistical difference at 12 h or 24 h after fluid resuscitation （P 〈 0. 05 ） ;As the result of 57 survivors（ 83.8% ）, 11 deaths（ 16. 2% ）, 14 ARD$,7 ARF,the cure rate and morality, complications incidence as ARDS, ARF with significant difference by statistical analysis. Conclusion Limited fluid resuscitation ean availably improve organic tissue hemoperfusion at cure of HTS and its effectiveness on increasing cure rate and reducing morality is superior to routine fluid resuscitation.