限制性液体复苏对多发性骨折合并创伤失血性休克患者凝血功能、心肌损害指标及预后的影响

The Effect of Limited Fluid Resuscitation on Coagulation Function,Myocardial Damage Indexes and Prognosis in Patients with Multiple Fractures and Traumatic Hemorrhagic Shock

目的:探讨限制性液体复苏对多发性骨折合并创伤失血性休克患者凝血功能、心肌损害指标及预后的影响。方法:选取我院收治的多发性骨折合并创伤失血性休克患者77例,分为研究组(n=39)、对照组(n=38),对照组给予常规液体复苏,研究组给予限制性液体复苏,比较两组患者凝血功能、心肌损害指标、输液量、失血量、输血量、并发症发生率及病死率。结果:研究组的输液量、失血量、输血量均少于对照组(P<0.05)。与复苏前相比,两组患者复苏1 h后凝血酶原时间(PT)、凝血活酶时间(APTT)、凝血酶时间(TT)均延长,且研究组长于对照组(P<0.05);两组患者复苏1 h后肌酸激酶(CK)、肌酸激酶-同工酶(CK-MB)、肌钙蛋白T(CTnT)水平均下降,且研究组低于对照组(P<0.05)。研究组复苏期间并发症发生率、病死率均低于对照组(P<0.05)。结论:限制性液体复苏治疗多发性骨折合并创伤失血性休克患者,可改善患者凝血功能和预后,降低并发症发生率,同时还可减轻心肌损害。

Objective:To explore the effect of limited fluid resuscitation on coagulation function,myocardial damage indexes and prognosis in patients with multiple fractures and traumatic hemorrhagic shock.Methods:77 patients with multiple fractures and traumatic hemorrhagic shock who were admitted to our hospital were selected.According to the method of random number table,they were divided into control group(n=38)and study group(n=39).The control group was given routine fluid resuscitation,and the study group was given limited fluid resuscitation.The coagulation function,myocardial damage index,transfusion volume,blood loss volume,blood transfusion volume,complication rate and mortality rate were compared between the two groups.Results:The transfusion volume,blood loss volume and blood transfusion volume in the study group were less than those in the control group(P<0.05).The prothrombin time(PT),prothrombin time(APTT)and thrombin time(TT)in the two groups were all increased at 1 hour after resuscitation,and those in the study group were longer than those in the control group(P<0.05).Creatine kinase(CK),creatine kinase isoenzyme(CK-MB)and troponin T(cTnT)were all decreased in the two groups at 1 hour after resuscitation,and those in the study group were lower than those in the control group(P<0.05).The complication rate and mortality rate in the study group were lower than those in the control group(P<0.05).Conclusion:Limited fluid resuscitation in the treatment of multiple fractures with traumatic hemorrhagic shock can improve coagulation function and prognosis in patients with multiple fractures and traumatic hemorrhagic shock,which can reduce the incidence of complications and myocardial damage.