低血压复苏在抢救上消化道出血合并失血性休克的临床研究

Clinical study on resuscitation of low blood pressure in the treatment of uppergastr ointestinal hemorrhage complicated with hemorrhagic shock

目的探讨低血压复苏与快速大量补液复苏在抢救上消化道出血合并失血性休克患者在出血未控制的情况下的临床效果。方法采用回顾性研究急诊科抢救60例上消化道出血合并失血性休克患者在出血未控制的情况下的液体复苏方法,按不同时间段分为治疗组及对照组各30例。治疗组患者应用低血压复苏进行救治,对照组患者应用快速大量补液复苏方法进行救治,对两组患者的血红蛋白(Hb)、红细胞压积(HCT)、凝血酶原时间(PT)、血清乳酸(LA)、平均输液量、输血量、平均动脉压、死亡率进行统计学分析。结果采用两种不同复苏方式治疗后,低血压复苏组平均输液量(1050±50)m L,输血量(200±40)m L,平均动脉压(51.10±5.30)mm Hg,死亡率16.7%。快速大量补液复苏组平均输液量(3000±350)m L,输血量(1000±100)m L,平均动脉压(68.15±4.80)mm Hg,死亡率26.7%。两组间差异具有统计学意义(P<0.05)。而Hb、HCT、PT、LA的比较,两组差异具有统计学意义(P<0.05)。结论在抢救上消化道出血合并失血性休克患者在出血未控制的情况下,低血压复苏优于快速大量补液复苏。

Objective To investigate the clinical effect between low blood pressure resuscitation and rapid fluid resuscitation in the treatment of patients with upper digestive tract hemorrhage combined with hemorrhagic shock. Methods Retrospective study was used in 60 cases of upper gastrointestinal bleeding complicated with hemorrhagic shock and fluid resuscitation in uncontrolled hemorrhagic shock, all cases were divided into treatment group and control group according to different time period, 30 cases in each group. In treatment group patients were treated with low blood pressure recovery, while Patients in the control group were treated with rapid massive fluid resuscitation. Hemoglobin（Hb）, red blood cell（HCT）, prothrombin time（PT）, serum lactic acid（LA）, the average amount of infusion, blood transfusion, mean arterial pressure, mortality in two groups were statistically analyzed. Results After treatment with two different methods, the average amount of infusion in the resuscitation group of low blood pressure was（1050 ±50）ml,amount of blood transfusion was（200±40）ml,mean arterial pressure was（51.10±5.30）mmH g,mortality was 16.7%. In rapid massive fluid resuscitation group, the average volume of infusion was（3000±350）ml,amount of blood transfusion was（1000±100）ml,mean arterial pressure was（68.15±4.80）mmH g,mortality was 26.7%. The difference between two groups was statistically significant（P〈0.05）. And Hb, HCT, PT,LA comparison, the difference between two groups has statistical significance（P〈0.05）. Conclusion In the emergency treatment of hemorrhage of the upper gastrointestinal bleeding and hemorrhagic shock patients in uncontrolled bleeding, the recovery of low blood pressure is better than that of rapid resuscitation.