创伤失血性休克限制性液体复苏中急诊监测的临床意义

Clinical significance of emergency monitoring of the traumatic hemorrhagic shock resuscitation

目的研究限制性液体复苏在急诊抢救创伤失血性休克患者中观察指标的l临床意义。方法回顾性分析2006-01-2013-12在我院急救部救治的484例创伤失血性休克患者的临床资料，比较限制性液体复苏（限制组，n=293）和常规液体复苏（常规组，n=191）两种不同复苏方式对两组患者液体复苏前后红细胞比容（Hot）、血清乳酸（Lae）、凝血功能（国际标准化比值，INR）的影响，然后对两组观察终点患者死亡率进行比较分析。结果限制组手术前输液量为（1876±472）mL,常规组为（3021±646）mL，两组比较差异有统计学意义（t=13．88，P=0．00）；两种不同液体复苏方式治疗后，两组患者的Her（0．28±0．08VS0．23t0．11，t=2．14，P=0．03）、Lac[（1．27±1．05）mmol／Lv8（2．23±1．31）mmol／L，t=2．01，P=0．046]、INR（1．25±O．30vs1．52±0．48，t=2．89，P=0．04）等差异有统计学意义；观察终点限制组病死率为13．73％，非限制组病死率为17．07％，差异有统计学意义（r=52．25，P=0．00）。结论急诊对未控制出血的创伤失血性休克患者给予液体复苏治疗过程中，积极监测输液量、Her、Lac、INR等各项指标，可以为急诊治疗提供临床指导，从而增加该类患者的急诊抢救成功率。

Objective To explore the clinical significance of emergency monitoring in patients with traumatic hemorrhagic shock by limited fluid resuscitation. Methods This retrospective study included 484 in - hospital patients who were diagnosed as traumatichemorrhagic shock from January 2006 to December 2013. They were treated with limited fluid resuscitation （ limited group, n = 293 ） and traditional fluid resuscitation（ traditional group, n = 191 ）. Hct, serum lactic acid（Lac） and coagnlation function were compared before and after resuscitation. Results Fluid volume oflimited group and traditional group was significant different [ （ 1876 ± 472） mL vs （3021 ± 646） mL, t = 13.88, P = 0.00 ]. After fluid resuscitation, two groups of all markers were all obviously different with each other [ Hot （0.28±0.08 vs 0.23 ±0.11, t =2.14, P=0.03）, Lac[ （1.27 ± 1.05）mmol/L vs （2.23 ±1.31） retool/L, t =2.01, P=0.046）], INR（I.25 ±0.30 vs 1.52 ±0.48, t =2.89, P=0.04）]. Conclusion During patients with traumatic hemorrhagic shock by limited fluid resuscitation, emergency monitoring, such as transfusion volume, red blood cells, serum Lac and blood coagulation function indicators, can provide clinical guidance for emergency treatment, thus increasing emergency rescue success rate of the patients.