限制性液体复苏联合舒芬太尼对创伤失血性休克患者院前急救的影响

Influence of limited liquid resuscitation combined with sufentanil on pre-hospital first aid in patients with traumatic hemorrhagic shock

目的探讨限制性液体复苏联合舒芬太尼对创伤失血性休克患者院前急救的影响。方法回顾性分析2011年5月至2014年5月长寿区人民医院院前急救抢救成功的创伤失血性休克患者90例,分为限制性液体复苏联合舒芬太尼治疗组（A组）、限制性液体复苏组（B组）,常规补液复苏组（C组）,每组各30例。A组患者给予限制性液体复苏,使得平均动脉压在50mm Hg左右,同时给予舒芬太尼按照1~5μg/kg静脉2min推注,使得患者疼痛数字评分在3分以下;B组患者给予限制性液体复苏,使得平均动脉压维持在50mm Hg左右;C组患者给予充分液体复苏,使得平均动脉压在70mm Hg左右,不予以镇痛处理。观察三组患者入急诊科时液体复苏使用量,凝血酶原时间（PT）,血红蛋白（Hb）水平,氧合指数（PaO2/FiO2）、血清乳酸（BLAC）水平;入ICU后各组48h输血总量、伤后12h的C反应蛋白（CRP）及皮质醇浓度。结果 A、B两组与C组入急诊科时比较,A、B组使用的输液量明显较少,PT升高程度较低,Hb下降程度较轻,差异有统计学意义（P〈0.05）;且A组与B、C组比较,机体PaO2/FiO2指数更高及BLAC水平更低,差异有统计学意义（P〈0.05）;三组患者入ICU后,A组与B、C组比较,48h输血量更少,伤后12h反映机体应激状态的CRP及皮质醇浓度低,差异有统计学意义（P〈0.05）。结论限制性液体复苏联合舒芬太尼对于救治创伤失血性休克患者能够减少患者液体复苏量,并减少出血量,减轻创伤应激反应,进而减少创伤所致多器官功能不全的可能。

Objective To investigate the influence of limited liquid resuscitation combined with sufentanil on pre-hospital first aid in the patients with traumatic hemorrhagic shock.Methods 90 patients with traumatic hemorrhagic shock succeeded by pre-hospital first aid in the Changshou District People′s from May 2011 to May 2014 were retrospectively analyzed and divided into the limited liquid resuscitation combined with sufentanil group（group A）,limited liquid resuscitation group（group B）and conventional fluid replacement resuscitation group（group C）,30 cases in each group.The group A was given the limited liquid resuscitation for making the mean arterial pressure（MAP）at about 50 mm Hg,meanwhile giving sufentanil 1-5μg/kg by intravenous injection for 2min,making the patients pain digital score below 3points;the group B was given the limited liquid resuscitation for maintaining MAP at about 50 mm Hg;the group C was given the sufficient fluid resuscitation for maintaining MAP at about 70 mm Hg without analgesic treatment.The liquid resuscitation amount,prothrombin time（PT）,hemoglobin（Hb）level,oxygenation index（PaO2/FiO2）,blood lactic acid（BLAC）level were observed on the admission to the emergency department;the total blood transfusion amount at 48 hafter admission to ICU,C-reactive protein（CRP）and cortisol level at12 hafter injury were also observed.Results The fluid infusion amount on admission to the emergency department in the group A and B were significantly smaller than those in the group C,the PT elevation degree was lower,the Hb decrease degree was lighter,the difference was statistically significant（P〈0.05）;moreover the PaO2/FiO2 index in the group A was higher than that in the group B and C,while the BLAC level was lower,the difference was statistically significant（P〈0.05）;after admission to ICU,the 48 hblood transfusion amount in the group A was less than those in the group B and C,the CRP and cortisol levels at 12 hafter injury,which reflecting the body stress state,were lower,the difference was statistically significant（P〈0.05）.Conclusion The limited liquid resuscitation combined with sufentanil for rescuing the patients with traumatic hemorrhagic shock can reduce the amount of fluid resuscitation,decreases the bleeding amount,alleviates the traumatic stress reaction,thus reduces the possibility of trauma caused multiple organ insufficiency.