创伤性休克早期即刻液体复苏与延迟液体复苏的临床效果对比研究

Immediate versus delayed fluid resuscitation in early stage of traumatic shock

目的探讨延迟液体复苏在创伤性休克早期治疗中的应用效果。方法选取堰桥医院接诊的创伤性休克患者52例,随机分为观察组和对照组各26例。对照组采用即刻液体复苏方案,观察组采用延迟液体复苏方案。对比2组患者液体复苏前后的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、红细胞压积(HCT)、血乳酸(BL)、血pH值和碱缺失(BD)的检测结果,同时对比2组患者休克第1小时的补液量和病死率。结果观察组治疗前后的HCT、BL、pH值和BD水平比较,差异均没有统计学意义(均P>0.05);对照组治疗后的HCT为(16.93±2.07)%,显著低于治疗前(P<0.05),而治疗后的BL、PH值和BD水平和治疗前对比,差异均没有统计学意义(均P>0.05);观察组治疗后PT、APTT延长的患者各有8例,均显著少于对照组(均P<0.05);观察组休克第1小时的补液量为(486±291)ml,显著少于对照组(P<0.05);观察组的病死率为15.38%,与对照组对比,差异没有统计学意义(P>0.05);观察组存活患者液体复苏过程中并发症发生率为18.18%,对照组并发症的发生率为35.29%。观察组存活患者并发症发生率低于对照组,但差异没有统计学意义(P>0.05)。结论创伤性休克早期采用延迟液体复苏有利于保护患者的凝血功能,改善脏器组织的缺氧状态,提高临床抢救成功率。

Objective To investigate the effect of delayed fluid resuscitation in early treatment of traumatic shock. Methods Fifty-two patients with traumatic shock in our hospital were randomly divided into observation group and control group with 26 cases in each group. The patients in the control group received the immediate fluid resuscitation, while the observation group received the delayed fluid resuscitation. The prothrombin time （ PT）, activated partial thromboplastin time （APTT）, hematocrit（ HCT）, blood lactate（ BL）, blood PH and base deficit（BD） of the patients in both groups before and after the fluid resuscitation were compared. The resuscitating fluid in the first hour of shock and the mortality were compared between the two groups. Results The differences of HCT, BL, PH and BD before and after the treatment in the observation group were not statistically significant（ P 〉 0.05 ）. The HCT in the control group after treatment was（ 16.93 - 2.07 ） % ,significantly lower than that before the treatment（ P 〈 0.05 ） ,but BL,PH and BD was not（ P 〉0.05 ）. PT in 8 cases and APTT in 8 cases in the observation group increased after the treatment ,which was significantly less than those in the control group（ P 〈 0.05 ）. The resuscitating fluid in the first hour of shock of the observation group was（ 486± 291 ） ml, significantly less than the control group（ P 〈 0.05 ）. The mortality rate in the observation group was 15.38%, which was not statistically significant as compared with the control group（ P 〉 0.05 ）. The incidence of complications of survival patients in the observation group was 18.18% ,and in the control group was 35.29%. The incidence of complication of the observation group was lower than that of the control group, but the difference was not statistical significant（ P 〉 0.05 ）. Conclusion Delayed fluid resuscitation for early traumatic shock is conducive to the protection of coagulation function in patients. It can improve the hypoxic state of the organs and tissue, and increase the clinical success rate.