损伤控制复苏在严重多发伤合并创伤失血性休克救治中的应用

Application of damage control resuscitation in treatment of severe multiple injuries combined with traumatic hemorrhagic shock

目的 探讨损伤控制复苏（damage control resuscitation,DCR）在抢救严重多发伤合并创伤失血性休克患者中的应用价值.方法 回顾性分析采用DCR救治严重多发伤合并创伤失血性休克患者27例（DCR组）,并与传统正压液体复苏治疗的32例患者（对照组）的结果进行比较.观察乳酸清除时间、凝血功能、DIC发病率及病死率等.结果 采用DCR救治严重多发伤合并创伤失血性休克患者疗效良好,乳酸清除时间短,凝血功能恢复快,DIC发病率及病死率显著降低,与传统正压液体复苏疗法比较,差异有统计学意义.结论 采用DCR能够明显提高严重多发伤合并创伤失血性休克患者的生存率,同时也为其他类型休克患者的复苏抢救提供了新的思路.

Objective To investigate the clinical value of damage control resuscitation （ DCR） in the treatment of severe multiple injuries combined with traumatic hemorrhagic shock. Methods A retrospective analysis was done on 27 patients with severe multiple injuries combined with traumatic hemorrhagic shock treated by DCR. Another 32 patients treated with traditional aggressive/normotensive fluid resuscitation were used as control. Lactic acid clearance time, coagulation, diffuse intravascular coagulation （DIC） morbidity, and mortality were observed and compared between two groups. Results Compared with traditional aggressive/normotensive fluid resuscitation, DCR had better curative effect, shorter clearance time of lactic acid, more rapid recovery of blood coagulation function and lower incidence of DIC morbidity and lower mortality for patients with severe multiple injuries combined with traumatic hemorrhagic shock. Conclusions In the treatment of severe multiple injuries combined with traumatic hemorrhagic shock, the use of DCR can remarkably improve the survival rate of patients and also provide a new way for resuscitation and rescue of other types of shock patients.