限制性液体复苏在创伤失血性休克患者术前治疗中的应用

Application of Limited Fluid Resuscitation in the Preoperative Treatment of Uncontrolled Trauma Hemorrhagic Shock Patients

目的:探讨创伤失血性休克患者液体复苏的最适目标血压。方法:1入选患者随机分为3组(组1、组2、组3)。2给予液体复苏分别使患者平均动脉压稳定在70-80mm Hg、50-60mm Hg,40-49mm Hg。3统计患者补液量、PT、APTT、血红蛋白、碱剩余、乳酸、体温、MODS发病率、病死率。结果:1三组患者一般情况无显著差异。2三组患者补液量及输注红细胞有差异(P<0.05),组1显著多于组2、组3(P<0.05),组2多于组3(P<0.05)。3三组间PT、APTT及血红蛋白(HGB)浓度有显著差异(P<0.05)。两两比较组1与组3PT、APTT显著长于组2,组1长于组3(P<0.05);组1血红蛋白浓度显著低于组2、组3,组2、组3间无显著差异。4三组间BE及乳酸有显著差异,(P<0.05),两两比较组1组、3乳酸及BE显著高于组2,组3高于组1。组1体温显著低于组2及组3,组2及组3无显著差异。5三组患者MODS及死亡率有显著差异,组3最高,组1次之,组2最低(P<0.05),两两比较仅组2和组3在MODS和死亡情况中差异均具有统计学意义。结论:平均动脉压50-60mm Hg是较理想的复苏目标值。血压过低会导致预后更差。

Objective： To probe the optimum target blood pressure for treatment of uncontrolled trauma hemorrhagic shock patients. Methods： （1）90 uncontrolled trauma hemorrhagic shock patients were divided into 3 groups randomly（groupl,group2,group3）. （2） Every group sustained different mean arterial pressure （MAP）by different fluid resuscitate, groupl 70-80mmHg, group2 50-60mmHg, group 3 40-49mmHg. （3）General conditions, APTr, PT, HGB, BE, blood lactic acid, and the incidence of MODS, mortality during hospitality. Results： （1）There is no significant difference in general condition among the 3 groups. （2）The volume of fluid and erythrocyte suspension of group 1 is more than the other tow groups（P〈0.05 ）, and there is significant difference between every tow groups（P〈0.05 ）. （3）PT and APTT of group2 are shorter than the other tow groups （P〈0.05）, and there is significant difference between every tow groups （P〈0.05）.The HGB level of group I is lower than the other tow groups （P〈0.05）, with no significant difference between group 2 and group3. （4）The BE and concentration of lactic acid of group2 are higher than the other tow groups （P〈0.05）and there is significant difference between every tow groups （P〈0.05）.The temperature of groupl is lower than the other tow groups （P〈 0.05 ）, with no significant difference between group 2 and group3. （5）Tbe incident of MODS and mortality in group2 is the lowest （P〈 0.05）, with significant difference between group2 and group 3 only. Conclusion： MAP 50-60mmHg is reasonable target blood pressure. Too low blood pressure lead to worse prognosis