限制性液体复苏在创伤失血性休克急救中的临床价值

Clinical value of preoperative limited fluid resuscitation in the emergency treatment of hemorrhagic traumatic shock

目的研究创伤性休克术前进行限制性液体复苏的作用及临界血压的界定。方法 98例严重多发伤合并失血性休克患者,按入院顺序随机分为两组:A组50例、B组48例。通过液体复苏使收缩压分别维持在80 mmHg(A组)或90 mmHg以上(B组)。比较两组液体治疗情况、临床特征及住院期间ARDS、ARF、SIRS的发生率和病死率。结果两组年龄、性别、损伤及休克程度,复苏及手术开始时间差异均无显著性;两组总输液量、浓缩红细胞输入量、血红蛋白含量、血小板及中性粒细胞(PMNs)差异均有显著性。两组pH、碱剩余(BE)差异均无显著性;而血浆渗透压、国际标准化比例(INR)、纤维蛋白原及电解质差异均有显著性。住院期间两组ARF发生率差异无显著性,ARDS、SIRS的发生率及病死率差异有显著性。结论术前限制性液体复苏可明显减少出血量,节约血源;同时减少了再出血及缺血再灌注损伤,降低了ARDS、SIRS及MODS等的发生率和死亡率。

Objective To study the effect of preoperative limited fluid resuscitation in treating hemorrhagic traumatic shock and determine the critical value of blood pressure. Method 98 patients with multiple injuries complicating with hemorrhagic shock were treated in our hospital from Apr. 2006 to Mar. 2010, and were randomly divided into group A （n=50） which the level of systolic blood pressure （SBP） maintaining above 80 mmHg and group B （n= 48 ） which the level of systolic blood pressure （SBP） maintaining above 90 mmHg according to sequence of in hospital. There was no significant difference between A and B in injury severity score （ISS） , compare was made between A and B in volume of transfusion, content of haemoglobin, counts of platelet and neutrophils, osmolality of plasma, pH, base excess values （BE） , international normalized radio （INR） , fibrinogen of plasma, electrolyte before operation and the incidence and the mortality of acute respiratory distress syndrome （ARDS） , acute renal failure （ARF） and systemic inflammation respeonse syndrome （SIRS） in hospital. Result There was no significant difference in age, gender, injury severity score, initiated resuscitation time and initiated operation time between group A and B （ P〉0.05 ） ; there was significant difference in the amount of transfusion, the amount of infused e- rythroeytes, content of haemoglobin, counts of platelet and neutrophils between group A and B before operation. There was no significant difference in pH and BE, and there was significant difference in osmolality of plasma, INR, fibrinogen of plasma and electrolyte between group A and B. There was no significant difference in the inci- dence of ARF between group A and B, the incidence and the mortality of ARDS and SIRS in group B was higher than that of group A. Conclusion The preoperative limited resuscitation in patients with hemorrhagic traumatic shock can evidently reduce the amount of bleeding, economize transfusion, alleviate the injury of rebleeding and ischemia/reperfusion, and reduce the incidence and mortality of ARDS and SIRS.