多发性创伤伴失血性休克限制性液体复苏的疗效分析

Therapeutic effects of limiting fluid resuscitation on multiple injure and traumatic hemorrhagic shock

目的评价多发性创伤伴失血性休克早期采用限制性液体复苏(LFR)的治疗效果,以提高治愈率。方法将50例多发性创伤伴失血性休克患者随机分为LFR组和积极液体复苏(AFR)组,采用两组不同复苏方式,对两组患者的血乳酸(LA)、剩余碱(BE)、输入液体量进行统计学分析,对比两组的临床疗效。结果采用两种不同复苏方式治疗后,血乳酸[手术开始时:(3.26±0.52)mmol/Lvs(5.71±0.58)mmol/L;术后3小时:(2.35±0.36)mmol/Lvs(3.87±0.24)mmol/L]和剩余碱[手术开始时:(-5.56±0.49)mmol/Lvs(-9.48±0.71)mmol/L;术后3小时:(-3.54±0.22)mmol/Lvs(-5.34±0.68)mmol/L],两组间差异具有统计学意义(P<0.05)。限制液体复苏组输液量、死亡率比较积极液体复苏组差异具有统计学意义[(1075±259)mlvs(2568±360)ml;(14.5%vs35.4%),P均<0.05)]。结论在出血未控制的情况下,早期限制性液体复苏在减少输液量的同时可维持重要脏器的血流灌注,减轻酸中毒,为后续救治创造条件,降低病死率。

Objective for improving the cure rate of patients with multiple injure and traumatic hemorrhagic shock,this study tried to evaluate the therapeutic effects of limiting fluid resuscitation（LFR）.Methods the fifty patients with multiple injure and traumatic hemorrhagic shock were randomly divided into two groups which included the limiting fluid resuscitation（LFR） group and the aggressive fluid resuscitation（AFR） group,after treatment,serum lactate level,base excess（BE） in blood and inputting fluid of blood were compared between the two groups.Results There were significant differences in serum lactate and base excess（BE）between the two groups（P 0.05）.The serum lactate of pre-surgery was（3.26±0.52） mmol/L vs（5.71±0.58） mmol/L respectively while 3hours later after operation reduced to（2.35±0.36） mmol/L vs（3.87±0.24） mmol/L.The base excess（BE） of pre-surgery was（-5.56±0.49） mmol/L vs（-9.48±0.71） mmol/L,compared to（-3.54±0.22） mmol/L vs（-5.34±0.68） mmol/L three hours later after operation.Meanwhile,the inputting fluid [（1075±259）ml vs（2568±360）ml P 0.05] and mortality.[（14.5% vs35.4 %,P 0.05）]were diffrent beween the LFR group and AFR group.Conclusion If hemorrhage is not controlled,limited fluid resuscitation can maintain blood perfusion of vital organs,alleviate acidosis,reduce mortality and creat good conditions for advanced teatment.