乳酸清除率指导多发伤失血性休克液体复苏治疗探讨

Clinical trial of lactate clearance rate as guide of fluid resuscitation in multiple trauma patients with hemorrhage shock

目的：探讨乳酸清除率在指导多发伤并失血性休克液体复苏中的效果。方法选取多发伤并失血性休克的患者63例，分为两组，A组32例，B组31例。A组检测中心静脉压（CVP）及平均动脉压（MAP）指导补液，以CVP达到8～12mmHg，MAP达到（65±5）mmHg以上，作为液体复苏治疗的目标。B组在达到上述CVP及MAP的基础上，计算乳酸清除率，以乳酸清除率大于或等于10％作为复苏治疗的目标，观察两组患者术后2h液体复苏达标率及乳酸清除率大于或等于10％的比例、术后24h输液量的差异，两组患者住院期间器官功能不全发生情况，ICU住院日。结果2h液体复苏达标率的比例A组高于B组（P＜0．01）、24h内输入液体量B组大于A组（P＜0．01）。但两组术后24h液体复苏达标率（≥10％）的比例、输入红细胞及血浆量比较，差异无统计学意义（P＞0．05）。A组发生器官功能不全比例高于B组（P＜0．05），A组ICU平均住院日高于B组（P＜0．01）。结论在监测CVP及MAP的基础上，使用乳酸清除率作为创伤失血性休克液体复苏治疗的指导目标，可能减少患者器官功能不全发生，缩短ICU住院日。

Objective To evaluate the effect of the lactate clearance rate as a guide of the fluid resuscitation in multiple trauma patients with hemorrhage shock .Methods Sixty‐three multiple trauma patients with hemorrhage shock were divided into two groups ,which were group A （32 patients） and group B （31 patients） .In group A ,the central venous pressure （CVP） between8 and 12 mm Hg ,and the mean arterial pressure （MAP） （65 ± 5） mm Hg served as the goals of the fluid resuscitation .The B group ap‐plied the same goals of the CVP and MAP as group A .In addition ,the calculated lactate clearance rate （≥10% ） was used as the treatment target .The percent of patients reaching resuscitation goals and the ratio of the lactate clearance rate （≥10% ） at 2 hours after surgery ,the volume difference of infusion during the first 24 hours ,the incidences of organ dysfunction ,and the average days in ICU were compared between the two groups .Results The percent of patients reaching resuscitation goals at 2 hours after sur‐gery of group A was significantly higher than that of group B（P0 .05） .The incidence of organ dysfunction of group A was higher than that of group B （P〈0 .05） .The average days in ICU of group A were longer than that of group B（P〈0 .01） .Conclusion Based on monitoring CVP and MAP ,fluid resuscitation under the guidance of the lactate clearance rate（≥10% ）may decrease the incidences of organ dysfunction and the days of patients in ICU .