限制性液体复苏治疗创伤失血性休克临床分析

Analysis of restrictive fluid resuscitation in traumatic hemorrhagic shock treatment

目的探讨限制性液体复苏在治疗创伤失血性休克出血未控制阶段中的应用价值。方法回顾分析151例创伤性肝(脾)破裂致失血性休克患者临床资料,依据复苏过程中平均动脉压水平进行分组,比较充分液体复苏和限制性液体复苏对创伤出血量、血红蛋白、凝血功能、动脉血乳酸、创伤并发症以及死亡率等方面的影响。结果限制性液体复苏在降低创伤失血、避免血液稀释、维持凝血功能、改善组织灌注、减少急性肺损伤等方面均明显优于充分液体复苏,但复苏过程中,过低的平均动脉压可能造成组织灌注不足并增加急性肾损伤风险。结论在创伤失血性休克的出血未控制阶段进行限制性液体复苏具有多方面的积极意义。

Objective To explore the effect of restrictive fluid resuscitation in treating traumatic hemorrhagic shock patients with uncontrolled hemorrhage. Methods All 151 cases of traumatic hemorrhagic shock patients were analyzed retrospectively and divided into restrictive fluid resuscitation group and aggressive fluid resuscitation group based on the level of mean arterial pressure during the resuscitation. To compare the blood loss volume,hemoglobin,coagulation function,arterial blood lactate level,traumatic complications and mortality between restrictive fluid resuscitation group and aggressive fluid resuscitation group. Results Restrictive fluid resuscitation group showed superior to aggressive fluid resuscitation group in reducing blood loss,avoiding hemodilution,preserving normal coagulation function,improving tissue perfusion and lowering acute lung injury risks. However,excessively low mean arterial pressure during fluid resuscitation may result in tissue hypoperfusion and acute kidney injury. Conclusion Restrictive fluid resuscitation is preferable for traumatic hemorrhagic shock patients with uncontrolled hemorrhage.