骨盆型严重多发伤失血性休克的限制性容量复苏

Limited resuscitation for severe polytrauma patients complicated with pelvic injury and hemorrhagic shock

目的通过采集骨盆型严重多发伤的病例资料,总结和分析其病情特点,为临床上骨盆型严重多发伤应用损害控制提供初步依据。方法对我院2000年1月-2007年7月间的60例骨盆型严重多发伤患者进行回顾性研究。对其中21例伴有失血性休克患者通过损伤严重度评分（ISS）、早期复苏输液量、复苏时间等指标进行量化分析和疗效评估。结果21例伴有失血性休克,根据早期复苏方法分为限制性复苏组（11例）和常规复苏组（10例）。限制性复苏组：ISS评分30.72,复苏输液量1009.09ml,复苏时间102.72分钟,复苏后血红蛋白（HGB）98.36g/L;常规复苏组：ISS评分30.90,复苏输液量3 175ml,复苏时间246分钟,复苏后HGB 79.90g/L。限制性复苏组和常规复苏组ISS评分无显著性差异（P〉0.05）,复苏输液量、复苏时间、复苏后HGB均有显著性差异（P〈0.05）。结论在急救复苏过程中,对伴有失血性休克的骨盆型严重多发伤患者进行限制性复苏,能使输液量更少,控制出血更好,复苏效果更显著。

Objective To collect the data of severe polytrauma patients who have mainly sustained pelvic trauma,and to analyze and summarize the feature of its pathogenetic condition,then provide initial evidence for treatment by applying damage control.Methods Totally 60 severe polytrauma patients who mainly sustained pelvic trauma in our department between Jan.2000 and Jul.2007 were retrospectively reviewed.The ISS,early transfusion quantity and resuscitation time of 21 of them with hemorrhagic shock were analyzed and evaluated.Results There were 21 cases accompanied with hemorrhagic shock.They were divided into limited resuscitation group and routine resuscitation group according to early resuscitation method.The limited resuscitation group showed average ISS 30.72,average resuscitation volume 1009.09 ml,average resuscitation time 102.72 minutes,average HGB after resuscitation 98.36 g/L.The routine resuscitation group showed average ISS 30.90,average resuscitation volume 3175.00 ml,average resuscitation time 246.00 minutes,average HGB after resuscitation 79.90 g/L.Between the limited resuscitation group and the routine resuscitation group,there was no significant difference for the ISS（P0.05）,but significant difference for the resuscitation volume（P0.05）,the resuscitation time（P0.05）,the HGB after resuscitation（P0.05）.Conclusion During the emergency resuscitation,the severe polytrauma patients who mainly sustained pelvic trauma accompanied with hemorrhagic shock are treated by the limited resuscitation,which can reduce resuscitation volume,better control hemorrhage,and make the resuscitation effect more remarkable.