3%高渗盐水对严重创伤合并肺挫伤患者肺功能的影响

Effect of 3% Hypertonic Saline on Pulmonary Function in Patients with Severe Trauma and Pulmonary Contusion

目的探讨3%高渗盐水液体复苏对严重创伤合并肺挫伤患者肺功能的影响。方法将60例严重创伤合并肺挫伤患者按治疗方法的不同分为试验组和对照组,每组30例。2组均给予脉波轮廓温度稀释连续心排量监测前后负荷和心排量(胸腔内血容积指数、血管外肺水指数、外周血管阻力指数、心排血量等)。在此基础上,试验组给予3%高渗盐水进行液体液体复苏,对照组给予生理盐水进行液体复苏。对2组复苏开始后1、6、24h的血管外肺水指数、Murray肺损伤评分及呼吸机通气时间和患者ICU生存率、28d生存率进行比较。结果试验组复苏开始后1、6h的血管外肺水指数值及1、6、24h的Murray肺损伤评分均较对照组降低(均P<0.05)。2组复苏开始后24h的血管外肺水指数值及呼吸机通气时间和患者ICU生存率、28d生存率比较差异无统计学意义(P>0.05)。结论 3%高渗盐水参与的液体复苏,可以有效降低严重创伤合并肺挫伤患者短期的肺渗出,对肺损伤有保护作用,但未能改善患者预后的指标。

Objective To investigate the effect of fluid resuscitation with 3% hypertonic saline on pulmonary function in patients with severe trauma and lung contusion.Methods Sixty patients with severe trauma and lung contusion were divided into experimental group and control group,with 30 patients in each group.All patients were given pulse-induced contour cardiac output monitoring to measure the preload,afterload and cardiac output（intrathoracic blood volume index,extravascular lung water index,peripheral vascular resistance index,cardiac output,etc.）.In addition,the experimental group and control group were treated with 3% hypertonic saline and normal saline for fluid resuscitation,respectively.Extravascular lung water index and Murray lung injury score were measured 1,6and 24 hours after the beginning of resuscitation.Furthermore,ventilation time,ICU survival rate and 28-day survival rate were compared between the two groups.Results Compared with control group,extravascular lung water index decreased 1and 6hours after the beginning of resuscitation,and Murray lung injury score reduced 1,6and 24 hours after the beginning of resuscitation（P〈0.05）.There were no significant differences in ventilation time,ICU survival rate and 28-day survival rate between the two groups（P〉0.05）.Conclusion Fluid resuscitation with 3% hypertonic saline reduces lung effusion index and lung injury,but fails to improve prognostic indicators in patients with severe trauma and lung contusion.