限制性液体复苏在胸腹联合伤致创伤失血性休克中的应用研究

Application value of restricted fluid resuscitation in patients with traumatic hemorrhagic shock caused by thoraco-abdominal injury

目的探讨限制性液体复苏在胸腹联合伤致创伤失血性休克中的应用价值。方法按照随机数字法,将2018年1-12月该院收治的100例胸腹联合伤致创伤失血性休克患者分为限制组与常规组,每组50例。限制组实施限制性液体复苏,常规组实施常规液体复苏。分析液体复苏前及液体复苏2h后凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血乳酸(BLA)、血红蛋白(Hb)、碱剩余(BE)、血小板(PLT)、氧输送(DO2)、氧消耗(VO2)、混合静脉血氧饱和度(SvO2)变化情况,比较患者存活率及急性呼吸窘迫综合征(ARDS)、多器官功能障碍综合征(MODS)、弥散性血管内凝血(DIC)发生情况。结果液体复苏2h后,所有患者PT、APTT、BLA水平均降低(P<0.05),Hb、BE、PLT、DO2、VO2、SvO2水平均增高(P<0.05)。液体复苏2h后,限制组PT、APTT、BLA水平低于常规组(P<0.05),Hb、BE、PLT、DO2、VO2、SvO2水平均高于常规组(P<0.05)。限制组患者存活率为92.0%,ARDS、MODS、DIC发生率分别为22.0%、20.0%、6.0%;常规组患者存活率为80.0%,ARDS、MODS、DIC发生率分别为36.0%、36.0%、22.0%。限制组患者存活率高于常规组(P<0.05),ARDS、MODS、DIC发生率低于常规组(P<0.05)。结论限制性液体复苏能够改善胸腹联合伤致创伤失血性休克患者凝血功能、器官血流灌注及氧代谢,提高患者存活率,降低并发症发生率。

Objective To investigate the application value of restricted fluid resuscitation(RFR) in patients with traumatic hemorrhagic shock(THS) caused by thoraco-abdominal injury(TAI). Methods A total of 100 patients with THS caused by TAI were divided into restricted group and conventional group by using random number method in this hospital from Jan.to Dec.2018,with 50 cases in each group.RFR was carried out in restricted group and conventional liquid resuscitation(CLR) was carried out in conventional group.Changes of the laboratory indexes,including prothrombin time(PT),activated partial thrombin time(APTT),blood lactic acid(BLA),hemoglobin(Hb),base excess(BE),platelet(PLT),oxygen transport(DO 2),oxygen consumption(VO 2),mixed venous oxygen saturation(SvO 2),were analyzed before and 2 h after liquid resuscitation.The survival rate and complications,including acute respiratory distress syndrome(ARDS),multiple organ dysfunction syndrome(MODS) and disseminated intravascular coagulation(DIC),were observed in the two groups. Results 2 h after liquid resuscitation,levels of PT,APTT and BLA were significantly decreased,and levels of Hb,BE,PLT,DO 2,VO 2 and SvO 2 were significantly increased in both groups( P < 0.05 ).Levels of PT,APTT and BLA in restricted group were significantly less than conventional group,and levels of Hb,BE,PLT,DO 2,VO 2 and SvO 2 in restricted group were significantly higher than conventional group( P <0.05).In restricted group,the survival rate was 92.0%,and the incidence of ARDS,MODS and DIC were 22.0%,20.0% and 6.0%,respectively.In conventional group,the survival rate was 80.0%,and the incidence of ARDS,MODS and DIC were 36.0%,36.0% and 22.0%,respectively.The survival rate of restricted group was significantly higher than conventional group( P <0.05), and the incidence of ARDS,MODS and DIC were significantly lower than conventional group( P <0.05). Conclusion RFR could improve the coagulation function,organ blood perfusion and oxygen metabolism,increase the survival rate and reduce the incidence of complications in patients with THS caused by TAI.