限制性液体复苏抢救非控制性失血性休克临床观察

Clinical observation of limited fluid resuscitation on preoperative uncontrolled hemorrhagic shock

目的探讨限制性液体复苏在抢救创伤非控制性失血性休克中的价值。方法创伤非控制性失血性休克患者114例随机分为限制性液体复苏组(观察组)和积极液体复苏组(对照组)各57例,比较2组术前输液量、病死率、血红蛋白、血小板计数、凝血酶原时间、血气剩余碱及并发症发生率。结果对照组病死率(15.79%)高于观察组(10.53%)(P<0.05),并发症发生率(29.17%)高于观察组(21.57%)(P<0.05);术前剩余碱对照组((215±87)mmol/L)较观察组((272±93)mmol/L)减少(P<0.05),对照组凝血酶原时间((14.5±1.8)s)较观察组((12.3±1.7)s)延长(P<0.05)。结论术前急救采用限制性液体复苏可维持重要器官血流灌注,降低早期大量输液导致的并发症,降低病死率。

Objective To evaluate the effect of limited fluid resuscitation on uncontrolled traumatic hemorrhagic shock and its clinical value. Methods A total of 114 patients with uncontrolled traumatic hemorrhagic shock were randomly divided into limited fluid resuscitation group （experimental group） and active fluid resuscitation group （control group）, with 57 cases in each group. These two groups were compared the preoperative transfusion quantity, fatality rate, hemoglobin, platelet count, prothrombin time, base excess and incidence rate of complications. Results The fatality rate and incidence rate of complications were 15.79% and 29. 17% in control group, higher than those in experiment group （10.53% and 21.57%） （P〈0.05）. The preoperative base excess was （215±87） mmol/L in control group, lower than that in experiment group （（272±93） mmol/L） （P〈0, 05）. The prothrombin time was （14.5±1.8）s in control group, longer than that in experiment group （（12. 3 ±1. 7）s） （P〈0. 05）. Conclusions Limited fluid resuscitation in preoperative emergency treatment can maintain the blood perfusion in important organs and reduce the complications caused by a great quantity of transfusion in the early period so as to improve the prognosis and reduce the fatality rate.