限制性液体复苏在急诊骨盆骨折伴失血性休克患者中的应用效果

Application effect of restricted fluid resuscitation in emergency pelvic fractures with hemorrhagic shock

目的探讨限制性液体复苏在急诊骨盆骨折伴失血性休克患者中的应用效果。方法回顾性分析北京市顺义区医院急诊外科2015年8月~2019年10月收治的98例骨盆骨折伴失血性休克患者的临床资料,按照不同液体复苏方式分为限制组(51例)和对照组(47例)。对照组采用常规液体复苏方式,限制组采用限制性液体复苏方式。比较两组患者急性呼吸窘迫综合征(ARDS)、多器官功能障碍综合征(MODS)和死亡率,并对两组临床指标和实验室指标、氧代谢指标进行比较。结果限制组患者ARDS、MODS和死亡率低于对照组,差异有统计学意义(P<0.05)。限制组复苏后损伤程度量表(ISS)评分低于对照组,复苏时间短于对照组,输液量少于对照组,差异有统计学意义(P<0.05)。限制组复苏后血乳酸含量低于对照组,凝血酶原时间(PT)短于对照组,红细胞比容(HCT)、血小板计数(PLT)水平高于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者氧代谢指标比较,差异无统计学意义(P>0.05);治疗后限制组动脉血氧含量(CaO2)、摄氧率(O2ER)高于对照组,动-静脉血氧含量差(Da-jvO2)低于对照组,差异有统计学意义(P<0.05)。结论限制性液体复苏在急诊治疗骨盆骨折伴失血性休克中,抢救成功率高,复苏时间短,并发症发生率低,值得临床进一步推广。

Objective To explore the application effect of restricted fluid resuscitation in emergency pelvic fractures with hemorrhagic shock.Methods Clinical data of 98 patients of pelvic fracture with hemorrhagic shock admitted to the Emergency Surgery of Shunyi District Hospital of Beijing City from August 2015 to October 2019 were retrospectively analyzed,and they were divided into the restricted group(51 cases)and the control group(47 cases)according to the different fluid resuscitation methods.The control group used conventional fluid resuscitation and the restricted group used restrictive fluid resuscitation.The acute respiratory distress syndrome(ARDS),multiple organ dysfunction syndrome(MODS)and mortality were compared between the two groups,and the clinical and laboratory and oxygen metabolism indexes were compared between the two groups.Results ARDS,MODS and mortality in restricted group were lower than those in control group,and the differences were statistically significant(P<0.05).After resuscitation,the ISS score in the restricted group was lower than that in the control group,the resuscitation time was shorter than that in the control group,and the infusion volume was lower than that in the control group,the differences were statistically significant(P<0.05).The serum lactate content in the restricted group after resuscitation was lower than that in the control group,the prothrombin time(PT)was shorter than that in the control group,hematocrit(HCT)and blood platelet(PLT)levels were higher than those in the control group,the differences were statistically significant(P<0.05).Before treatment,there was no significant difference in oxygen metabolism between the two groups(P<0.05).After treatment,CaO2 and O2ER in the restricted group were higher than those in the control group,while Da-jvO2 in the restricted group was lower than that in the control group,and the differences were statistically significant(P<0.05).Conclusion Restrictive fluid resuscitation in emergency treatment of pelvic fracture with hemorrhagic shock,the success rate of rescue is high,the time of resuscitation is short,and the incidence of complications is low,it is worthy of further clinical promotion.