严重闭合性创伤失血性休克院前两种液体复苏方法的比较

Comparison of pre-hospital fluid resuscitation in patients with severe closed trauma combined with hemorrhagic shock

目的评估院前不同液体复苏方法对严重闭合性创伤失血性休克患者的影响。方法 76例符合诊断标准的严重闭合性创伤失血性休克的患者,随机分为两组,限制液体复苏组和常规液体复苏组,各38例。比较两组入院前后一般临床特征及治疗情况、住院期间器官衰竭、感染发生率和病死率。结果院前两组比较,限制液体复苏组输液量较常规液体复苏组显著降低[(789.6±109.4)ml vs(2381.9±403.5)ml,P<0.01],院前复苏时间明显缩短[(59.3±15.5)min vs(80.1±17.4)min,P<0.01];院内实验室检查及治疗情况,限制液体复苏组血红蛋白(Hb)升高[(101.0±12.9)g/L vs(92.1±11.8)g/L,P<0.01],凝血功能好转[(78.8±8.2)%vs(63.1±12.6)%,P<0.01],输入血制品减少[浓缩红细胞:(6.4±2.1)U vs(7.5±4.6)U,P<0.01;冷冻血浆(5.1±3.0)U vs(6.4±2.0)U,P<0.01];住院期间限制液体复苏组器官衰竭发生率(21.0%vs 39.4%,P<0.01)和感染发生率(13.1%vs 26.5%,P<0.01)等并发症降低。结论院前维持适量的液体复苏可在一定程度上改善休克期机体的氧供和凝血功能状态,并降低创伤后期器官衰竭和感染发生率。

Objective To evaluate the effect of pre - hospital fluid resuscitation on patients with traumatic hemorrhagic shock. Methods 76 patients identified by severe closed trauma combined with uncontrolled hemorrhagic shock were divided into two groups. The patients were pair matched 38 patients each , dependent on the difference in pre - hospital fluid resuscitation input volume, that is, restrictive fluid resuscitation and routine fluid resuscitation. The general clinical symptoms, treatment, organ failure in hospital, inci- dence and mortality rate of infection before and after admission were compared. Results Pre - hospital comparison of the two groups ： infusion volume decreased sharply in the group of restrictive fluid resuscitation, [ （789.6 ± 109.4 ） ml vs （ 2381.9± 403.5 ） ml, P 〈 0. 01 ], resuscitation time shortened obviously [ （ 59.3 ± 15.5） min vs （ 80.1 ±17.4） min,P 〈 0. 01 ]. Laboratory tests and treatment in hospital： hemoglobin increased sharply in group of restrictive fluid resuscitation [ （ 101.0 ± 12.9） g/L vs （92.1 ± 11.8） g/L,P 〈 0.011, coagulation function improved [ （ 78.8 ± 8.2 ） % vs （ 63.1±12.6 ） %, P 〈 0.01 ], blood products input reduced, [ CRBC ： （ 6.4 ±2.1 ） U vs （ 7.5 ±4.6 ） U, P 〈 0.01 ; frozen plasma （ 5. 1± 3.0 ） U vs （ 6.4± 2.0 ） U, P 〈 0.01 ]. Organ failure in group of restrictive fluid resuscitation （21.0% vs 39.4% , P 〈 0.01 ） , infection incidence rate （ 13.1% vs 26.5 % , P 〈 0. 01 ） and other complications decreased. Conclusions Maintaining moderate fluid resuscitation pre - hospital improves coagulation function and oxygen supply, and decreases organ failure including infection incidence rate.