损伤控制性液体复苏用于重度创伤性休克患者的效果观察

Effects of damage control fluid resuscitation in patients with severe traumatic shock

目的观察损伤控制性液体复苏（damage control fluid resuscitation, DCR）用于重度创伤性休克患者的疗效，探讨该类患者麻醉中适宜的液体管理方案。方法81例重度创伤性休克并实施手术的患者，采用随机数字表法分为DCR组（43例）和常规液体复苏组（对照组，38例），分别在人室即刻（T1）、术毕即刻（T2）、术后12h（T3）、术后24h（T4）检测凝血酶原时间（prothrombintime，PT）、活化部分凝血活酶时间（activated partial thromboplastin time, APTT）、国际标准化比值（internationalnormalized ratio，INR）、pH值、乳酸、剩余碱（baseexcess，BE）、体温，并记录出血量、死亡例数。结果与对照组比较，DCR组T2、T3、T4时点的PT、APTT、INR值明显降低（P〈0．05）；T2、T3、T4时乳酸值明显降低，pH、BE值明显升高（P〈0．05）；T3、T4体温明显升高（P〈0．05）；出血量、病死率明显低于对照组（P〈0．05）.结论对于重度创伤性休克患者，DCR方案可明显改善凝血功能、缓解酸中毒、维持体温，改善预后。

Objective To observe the therapeutic effects of damage control fluid resuscitation （DCR） in patients with severe traumatic shock and discuss the suitable fluid management solutions during anesthesia for this kind of patients. Methods 81 patients with severe traumatic shock undergoing operation were divided into two groups： DCR group and conventional fluid resuscitation group （control group）. Prothrombin time（PT）, activated partial thromboplastin time（AVIT）, international normalized ratio （INR）, pH, lactic acid, base excess（BE）, and body temperature were separately detected at the time of entrance, the end of surgery,12, 24 h after operation. The death numbers were also recorded. Results Compared with control group, PT, APTT, INR and lactic acid at the end of surgery, 12, 24 h after operation were significantly decreased in DCR group （P〈0.05）. pH, BE at the end of surgery,12, 24 h after operation were significantly increased in DCR group（P〈0.05）. The body temperature at the point of 12, 24 h after operation was significantly increased in DCR group（P〈0.05）. The bleeding volume and mortality in DCR group were significantly lower than the control group （P〈0.05）. Conclusions For patients with severe traumatic shock, the DCR plan can correct the function of blood coagulation, alleviate acidosis, maintain body temperature, and improve the prognosis.