不同液体复苏在腹部多发伤导致失血性休克救治中的效果对比研究

A Comparative Study on Different Fluid Resuscitation in the Treatment of Hemorrhagic Shock Caused by Multiple Abdominal Injuries

目的:比较不同液体复苏在腹部多发伤导致的失血性休克救治中的临床效果及安全性。方法:选取2017年7月至2019年12月我院救治的因高处坠落、交通事故等意外事件导致腹部多发伤且失血性休克的患者83例,根据入院时间分为2组,对照组(于2017年7月至2018年7月入院治疗)和研究组(于2018年8月至2019年12月入院治疗)。在治疗过程中,对照组采用常规充分液体复苏;研究组采用限制性液体复苏。观察和比较两组患者临床治疗效果、血液酸度及其他相关指标。结果:复苏后,两组动脉血氧分压(Partial arterial oxygen pressure, PaO_(2))均较复苏前显著下降(P<0.05),对照组PaO_(2)较研究组更明显,在复苏后90 min、120 min,对照组PaO_(2)明显低于研究组(P<0.05)。两组复苏后动脉血二氧化碳分压(Partial pressure of blood carbon dioxide, Pa CO2)均呈现先下降后上升的变化趋势,对照组Pa CO2均显著高于研究组(P<0.05)。从复苏前到复苏后,两组p H值均呈现先降后升的变化趋势,同时在复苏后90 min、120 min研究组p H值均显著高于对照组(P<0.05)。与复苏前相比,两组复苏后PT值均显著上升(P<0.05),研究组复苏后90 min、120 min PT值明显低于对照组(P<0.05),复苏后谷丙转氨酶(Alanine aminotransferase, ALT)、谷草转氨酶(Aspartate aminotransferase, AST)及肌酐水平均明显低于对照组(P<0.05)。对照组共有9例(22.50%)患者出现并发症或死亡,研究组共有5例(11.62%)患者出现并发症,无死亡;不良预后发生率明显低于对照组(P<0.05)。结论:对腹部多发伤失血性休克患者而言,采用早期限制性液体复苏可有效恢复患者血容量,对血液携氧能力、肝肾功能影响较小,安全性高,有利于患者预后恢复。

Objective: To compare the clinical effect and safety of different fluid resuscitation in the treatment of hemorrhagic shock caused by multiple bdominal injuries. Methods: From July 2017 to December 2019, 83 patients with multiple abdominal injury and hemorrhagic shock due to accidents such as falling from height, accident were selected in our hospital. According to the time of admission were divided into two groups, the control group(admitted from July 2017 to July 2018), and the study group(admitted from August2018 to December 2019). During the course of treatment, the control group used conventional adequate fluid resuscitation, and the study group used restricted fluid resuscitation. Clinical efficacy, blood acidity and other related indexes were observed and compared between the two groups. Results: The PaO_(2) decreased significantly in the two groups after resuscitation(P<0.05), and the decrease trend of PaO_(2) in the control group was more obvious in the study group. At 90 min, 120 min PaO_(2) in the control group was significantly lower than that in the study group(P<0.05). After resuscitation, Pa CO2 in the two groups showed a trend of first decline and then increase, and Pa CO2 in the control group was significantly higher than that in the study group(P<0.05). From the pre-resuscitation to the post-resuscitation, the p H of the two groups showed a change trend of first descending and then rising, and the p H of the study group the study group was significantly higher than the control group at 90 min and 120 min after resuscitation(P<0.05). Compared with the pre-resuscitation, the PT values increased significantly after resuscitation in the two groups(P<0.05), while the PT values after resuscitation in the study group were were significantly lower than those of the control group at 90 min and 120 min(P<0.05). After resuscitation, the levels of ALT, AST and creatinine in the study group were significantly lower than those in the control group(P<0.05). In the control group, 9 cases(22.50 %)had complications or death, in the study group, 5 cases(11.62 %) had complications without death, and the incidence of adverse prognosis was significantly lower than that in the control group(P<0.05). Conclusion: For patients with multiple abdominal hemorrhagic shock,early restricted fluid resuscitation can effectively restore the patient’s blood volume, have a small effect on blood oxygen carrying capacity, liver and kidney function, and have high safety, which is conducive to recovery of patients’ prognosis.