创伤失血性休克早期不同液体复苏效果及对血气指标和凝血功能的影响

Study on effect of different fluid resuscitation on early stage of traumatic hemorrhagic shock and its influence on blood,gas indexes and blood coagulation function

目的探讨创伤失血性休克(HTS)患者应用限制性液体复苏与常规液体复苏的救治效果及对患者血气指标和凝血功能的影响作用。方法选取急诊科收治的148例HTS患者,根据就诊单双号分为常规组和限制性组各74例,常规组应用常规液体复苏予以抢救治疗,限制性组予以限制性液体复苏予以治疗。对比两组抢救效果及血气指标和凝血功能的差异。结果实施复苏治疗后30 min、60 min、120 min各时间点限制性组的动脉血氧分压(PaO_2)、剩余碱(BE)、pH测定值显著的高于常规组、动脉血二氧化碳分压(PaCO_2)、血乳酸(BL)测定值显著的低于常规组(P<0.05)。实施复苏治疗后120 min限制性组的凝血酶原时间(PT)、部分凝血活酶时间(APTT)、凝血酶时间(TT)测定值显著的低于常规组(P<0.05)。限制性组的多器官功能障碍综合征(MODS)(8.11%)、急性呼吸窘迫综合征(ARDS)(6.76%)、弥散性血管内凝血(DIC)(4.05%)发生率均显著的低于常规组(P<0.05);两组患者间肺部感染发生率差异无显著性(P>0.05)。限制性组的抢救成功率89.19%显著的高于常规组的75.68%(P<0.05)。结论 HTS患者应用限制性液体复苏进行抢救治疗能够更好地改善患者的血气指标、凝血功能,减少并发症的发生,提高治疗效果。

Objective To explore the effect of limited fluid resuscitation and conventional fluid resuscitation on patients with traumatic hemorrhagic shock（HTS）,and to study its effect on blood,gas indexes and blood coagulation function. Methods A total of 148 patients with HTS treated in emergency department were selected according to odd and even number into conventional group and restrictive group,each group with 74 cases. Patients in conventional group were applied with conventional fluid resuscitation for life - saving treatment,and patients in restric-tive group were received fluid resuscitation for treatment The rescue effect and blood,gas indexes and blood coagulation function were compared be-tween these 2 groups. Results After the implementation of the recovery treatment,arterial oxygen partial pressure（PaO2 ）,base excess（SBE） and pH value in patients of restrictive group were significantly higher than those of patients in conventional group,arterial carbon dioxide partial pressure（PaCO2 ）and levels of blood lactic acid（BL）were significantly lower than those of patients in conventional group（ P ﹤ 0. 05）. Recov-ery treatment after the implementation at different time points,prothrombin time（PT）,activated partial thromboplastin time（APTT）and throm-bin time（TT）in restrictive group were significantly lower than those of conventional group（ P ﹤ 0. 05）. The incidence rates of multiple organ dysfunction syndrome（MODS）（8. 11% ）,acute respiratory distress syndrome（ARDS）（6. 76% ）and diffuse intravascular coagulation（DIC） （4. 05% ）in restrictive group were significantly lower than those of conventional group（ P ﹤ 0. 05）. There was no significant difference in the in-cidence of pulmonary infection between these two groups（ P ﹥ 0. 05）. The successful rate of rescue in restrictive group was 89. 19% ,and it was higher than that（75. 68% ）of conventional group（ P ﹤ 0. 05）. Conclusion The application of limited fluid resuscitation in patients with HTS can better improve the blood gas index and coagulation function,reduce the occurrence of complications and improve the effect of treatment.