经骨髓腔输注高渗盐水治疗创伤失血性休克的临床研究

The study of treatment with 3% hypertonic saline via intraosseous access on hemorrhagic shock

目的:探讨经骨髓腔输注3%高渗盐水在创伤失血性休克患者早期液体复苏中的应用。方法:2015-04-2016-02将47例创伤失血性休克患者分为骨髓腔通路组(IO组)和外周静脉通路组(IV组),使用3%高渗盐进行液体复苏,对比2组患者建立通道时间、液体复苏前及之后30、60min时平均动脉压、血压、心率、电解质变化,观察治疗期间不良反应、后期MODS及病死率情况。结果:IO组建立输液通路时间显著性少于IV组(P<0.01),2组在液体复苏后30min升压效果达到峰值,但2组间各时间点血压回升差异无统计学意义,2组均未见明显不良反应,2组在液体复苏前后电解质改变及MODS、病死率差异无统计学意义。结论:在创伤失血性休克患者早期液体复苏中经骨髓腔通路与外周静脉通路输注3%高渗盐水均有助于提高和维持血压,但经骨髓腔通路输液更迅速、方便,是建立危重患者急救液体通道的可行方法。

Objective：To investigate the effects of 3% hypertonic saline（HS）resuscitation via intraosseous access on hemorrhagic shock patients in emergency treatment.Method：From April 2015 to February 2016,a total of47 patients with hemorrhagic shock were randomly divided into intraosseous access group（IO）and peripheral vascular access group（IV）,both groups received 3% hypertonic saline solution.The time of insertion was compared between two groups.Mean arterial pressure（MAP）,blood pressure（BP）,heart rate（HR）,and electrolytic indices were monitored and recorded before fluid infusion and at 30,60 minutes after infusion.The adverse effects,the incidence of complications and mortality rate were analyzed.Result：Compared with IV group,the time of insertion was significantly shorter in IO group.HS presented with a rapid and sustained restoration of MAP,which reached the peak at 30 minutes after infusion.But there was no significant difference in blood pressure at each time points.No severe adverse effects occurred in both groups,no significant difference in changes of electrolytic indices,mortality rate and MODS rate before and after treatment between two groups.Conclusion：Resuscitation with 3% HS via intraosseous access provide similar benefits Compared with peripheral vascular access on hemorrhagic shock.This highlights its valuable role as an alternative method of obtaining vascular access,vital when resuscitating the critically injured trauma patient.