限制性液体复苏治疗多发伤并出血未控制性休克术前的疗效观察

The Effect of Limited Fluid Resuscitation in the Treatment of Multiple Injuries with Uncontrolled Hemorrhagic Shock in Preoperative

目的:研究限制性液体复苏对多发伤并出血未控制性休克术前的治疗效果,探讨最佳的液体复苏方法。方法:选择2014年1月-2016年5月间经我院急诊科抢救的多发伤合并出血未控制性休克病例204例,根据液体复苏方法的不同分为充分液体复苏组(A组)和限制性液体复苏组(B组),B组又根据复苏中所选液体补液速度的不同分为B1组和B2组,比较不同复苏组间存活率、死亡率、MODS的发生率、碱剩余及血清乳酸值。结果:A组B组血气碱剩余值(BE)、血清乳酸值复苏后明显改善(P<0.05),B组改善程度更为显著(P<0.05)。B组、B1组和B2组死亡率和MODS发生率明显低于于A组,存活率明显高于A组(P<0.05);B1组和B2组在存活率、死亡率、MODS发生率上无显著性差异,但B1组输液总量明显少于B2组。结论:对于严重多发伤合并出血未控制性休克患者,正确及时的液体复苏能够有效恢复血容量,为后续治疗营造良好条件。早期采用限制性液体复苏能够提高患者的存活率,降低死亡率及MODS的发生率。

Objective ： To study the curative effect of the limited fluid resuscitation in the treatment of multiple injuries with uncontrolled hemorrhagic shock in preoperative and investigate the best method for fluid resuscitation.Methods： From January 2014 to May 2016, 204 cases of multiple injuries with uncontrolled hemorrhagic shock in the emergency department of our hospital were selected to divided into the full fluid resuscitation group（group A） and the limited fluid resuscitation group（group B） according to the different method of fluid resuscitation. The group B was divided into group B1 and group B2 according to the fluid infusion speed. The survival rate, mortality rate, the incidence of MODS,artery blood base excess and serum lactic acid value were compared among different groups.Results： About Artery Blood Base Excess, serum lactic acid value, there was a significant difference in group A and group B after fluid resuscitation（P〈0.05）, The improvement degree of group B was more significant（P〈0.05）. In improving the survival rate and reducing mortality rate and the incidence of MODS, group B 、group B1 and group B2 were significantly better than the group A. There was no significant difference in survival rate, mortality rate, MODS incidence between the group B1 and the group B2, but the total liquid of the B1 group was significantly less than that of the group B2. Conclusion For patients with multiple injuries combined with uncontrolled hemorrhagic shock,correct and timely fluid resuscitation can effectively restore blood volume and create favorable conditions for subsequent treatment. In early stage, limited fluid resuscitation can increase the survival rate, reduce the mortality rate and the incidence of MODS.