限制性液体复苏对严重多发伤休克患者乳酸清除率的影响

The Effect of Lactate Clearance Rate with Limited Fluid Resuscitation in Severe Multiple Traumatic Shock

目的:探讨限制性液体复苏对严重多发伤休克患者乳酸清除率的影响。方法:以60例严重多发伤休克患者为研究对象,并据收缩压目标不同分为常规液体复苏组(对照组)与限制性液体复苏组(实验组),每组均为30例。对比分析两组患者在接受治疗的不同时间点其乳酸清除率及复苏24小时后其氧合指数、凝血功能的变化。结果:分别予液体复苏3 h、6 h后,实验组的LCR分别是(0.20±0.01)、(0.35±0.05),与对照组相比差异有统计学意义(P值均<0.05)。予液体复苏24 h后,实验组的LCR与对照组相比无统计学意义(P>0.05)。实验组在液体复苏24小时后氧合指数较对照组明显升高,PT及APTT较对照组明显缩短,(P均<0.05)。结论:限制性液体复苏同样能有效改善严重多发伤休克患者的微循环组织灌注,且限制性液体复苏对于复苏后氧合指数及凝血功能障碍的影响较低,更适用于临床治疗。

Objective ： To investigate the effect of Lactate Clearance Rate（LCR） with different time points in severe multiple traumatic shock with limited fluid resuscitation. Methods ： In a prospective study, 60 patients with severe multiple traumatic shock were randomly divided into two groups according to the systolic pressure（SBP） ：control group and experimental group（30 cases each group）. After different fluid treatment, individual LCR was calculated at 3, 6, 24 hours for each patient, oxygenation index（OI） and coagulation function were compared between the two groups. Results ： The LCR of 3h and 6h after treatment in experimental group was（0.20 ±0.01） and（0.35±0.05）, which was significantly lower than in the control group（P〈0.05）. After 24 hours, the LCR of the two groups was no significant difference（P〈0.05）. 24 hours after the fluid resuscitation, the OI was significantly higher and prothrombin time（PT） and active partial thrombolastin time（APTT） were significantly shortened in the experimental group（P〈0.05）. Conclusion ： With severe multiple traumatic shock, limited fluid resuscitation enhanced microcirculation and improved tissue oxygenation after 24 hours. And it also had less impact on OI and coagulation. So it indicate that limited fluid resuscitation seemed beneficial in severe multiple traumatic shock.