限制性液体复苏救治上消化道出血并休克32例分析

Analysis on 32 cases of upper gastrointestinal hemorrhage complicated with shock treated by limited fluid resuscitation

目的探讨限制性液体复苏救治上消化道出血并休克的可行性。方法对32例上消化道出血并休克患者在彻底止血前采取限制性液体复苏,观察止血情况、再出血情况、死亡率及并发症。结果 32例中出血停止30例,有效率达93.8%,无急性呼吸窘迫综合征、急性肾衰竭、凝血障碍、严重感染等并发症,无再出血病例,出血不止行手术治疗1例,出血不止死亡1例。结论在彻底止血前采取限制性液体复苏救治上消化道出血并休克具有可行性,可维持重要器官的灌注,不干扰机体的代偿机制,避免形成的血栓脱落,避免出血加重,减少再出血及并发症,提高救治成功率,改善预后。

Objective To explore the feasibility of treating upper gastrointestinal hemorrhage complicated with shock by limited fluid resuscitation. Methods Limited fluid resuscitation was applied on 32 patients with upper gastrointestinal hemorrhage complicated with shock before thorough hemostasis to observe the status of hemostasis, the status of re-hemorrhage, mortality rate and complications. Results 30 out of 32 cases had hemostasis, with effective rate of 93.8%. No acute respiratory distress syndrome, acute renal failure, blood coagulation disorder, severe infection or other complications were observed. No re-hemorrhage case Was observed. 1 case with continuous hemorrhage was given surgical treatment and 1 case died from continuous hemorrhage. Conclusion It is feasible to apply limited fluid resuscitation for treatment of upper gastrointestinal hemorrhage complicated with shock before thorough hemostasis. It can maintain blood perfusion for vital organs, impose no interference on the compensatory mechanism of the body, avoid detachment of thrombus and aggravation of hemorrhage, reduce re-hemorrhage and complications, improve the success rate of treatment and improve prognosis.