外伤性肝脾破裂致失血性休克早期液体复苏的诊治探讨

Diagnosis and treatment of traumatic hemorrhagic shock caused by rupture of the liver and spleen on early fluid resuscitation

目的观察外伤性肝脾破裂致失血性休克早期限制性液体复苏和常规正压液体复苏的疗效对比。方法将81例外伤性肝脾破裂致失血性休克患者按随机原则分为限制性液体复苏组（41例,快速输入2∶1的平衡液和贺斯进行液体复苏,使平均动脉压（MAP）维持在50～70 mmHg（1 mmHg=0.133 kPa））和常规正压液体复苏组（40例,维持MAP在70～90mm Hg）。比较两组患者的输液量、凝血酶原时间（PT）,ARDS,MODS及治愈率。结果与常规正压液体复苏组比较,限制性液体复苏组输液量明显减少[（1240±243）ml比（2850±520）ml],PT明显缩短[（11.2±1.5）s比（15.9±1.7）s],治愈率明显升高（87.8%比62.5%）,差异均有统计学意义（均P〈0.05）。结论限制性液体复苏能降低未控制出血的患者的死亡率,能减少MODS和ARDS的发生率,提高其治愈率。

Objective To investigate the clinical therapeutic effect of early limited fluid resuscitation on patients with traumat- ic hemorrhagic shock caused by rupture of the liver and spleen. Methods Eighty-one patients with traumatic hemorrhagic shock caused by rupture of the liver and spleen were randomly divided into limited fluid resuscitation group（ n =41 ）and conventional positive pres- sure fluid resuscitation group（ n =40）. The patients in limited fluid resuscitation group were quickly infused by 2：1 balance solution and HS to carry out fluid resuscitation and maintain the mean arterial pressure （MAP） at 50-70 mmHg（ lmm Hg =0. 133 kPa） ,while in the conventional positive pressure fluid resuscitation group,the MAP was maintained at 70-90 mmHg. The amount of fluid applied in resuscitation,prothrombin time（PT） and cure rate between the two groups were compared. Results Compared with the conventional positive pressure fluid resuscitation group,the average transfusion quantity in the limited fluid resuscitation group was significantly de- creased [ （ 1 240±243 ） ml vs. （ 2850 ±520 ） ml ], the PT was markedly shortened [ （ 11.2 ± 1.5 ） s vs. （ 15.9 ± 1.7 ） s ], and the cure rate was obviously higher（ 87.8% VS. 62.5%, all P 〈 0. 05）. Conclusion The limited fluid resuscitation can induce full play of the blood coagulation and the organ compensatory mechanisms, promote the blood perfusion in vital organs, remarkably reduce the mortality and improve prognosis in patients with traumatic hemorrhagic shock.