早期限制性液体复苏抢救重度颅脑外伤合并失血性休克患者疗效分析

The effect and prognosis of early limited fluid resuscitation in the treatment of severe traumatic brain injury combined with hemorrhagic shock

目的探讨早期限制性液体复苏对重度颅脑外伤合并失血性休克患者抢救效果与预后的影响。方法回顾性分析2015年1月至2016年8月收治的108例经抢救后转入ICU的重度颅脑损伤合并失血性休克患者的临床资料,根据液体复苏方案不同,将其分为两组:常规组50例行常规充分液体复苏,研究组58例行早期限制性液体复苏。比较两组患者复苏效果、预后情况、并发症发生与病死情况。结果研究组患者总输液量、血清乳酸低于常规组(P<0.05);血小板、红细胞压积、凝血酶原时间高于常规组(P<0.05)。研究组预后良好率高于常规组(P<0.05);急性肾功能衰竭、弥散性血管内凝血、急性呼吸窘迫综合征、多器官功能障碍综合征等并发症总发生率与总病死率均低于常规组(P<0.05)。结论早期限制性液体复苏可有效改善重度颅脑外伤合并失血性休克患者的抢救效果与预后、降低并发症发生率与病死率,具有广阔的临床应用空间。

Objective To explore the effect of early limited fluid resuscitation on patients with severe traumatic brain injury combined with hemorrhagic shock and its effect on the prognosis of patients. Methods A retrospective study was performed on 108 cases after the rescue of severe craniocerebral injury combined into ICU in hemorrhagic shock from January in 2015 to August in 2016. According to the different liquid recovery plans,patients were divided into 2 groups： the control group,including 50 cases of routine adequate fluid resuscitation,and the study group,including 58 cases of early limited fluid resuscitation. The recovery,prognosis,complications and death were compared between the two groups. Results The total amount of infusion and serum lactic acid in the study group were significantly lower than those in the control group（ P〈0. 05）; the number of red blood cells,red blood cell pressure and prothrombin time in the study group were significantly higher than those in the control group（ P〈0. 05）. The prognostic and good rate in the study group was significantly higher than those in the control group（ P〈0. 05）; ARF,DIC,ARDS,MODS and other complications in the study group were significantly lower than those in the control group（ P〈0. 05）. Conclusion Early limited resuscitation in severe craniocerebral trauma combined with hemorrhagic application can effectively improve the prognosis of the patients condition of rescuing patients with shock,reduce the incidence of complications and mortality,which has a broad application space.