急诊超声在严重创伤失血性休克患者中的临床应用

Clinical Application of Emergency Ultrasound in Patients with Severe Traumatic Hemorrhagic Shock

目的:分析急诊超声在严重创伤失血性休克患者病情评估及救治中的临床应用价值。方法:选择2019年1月至2020年12月解放军91811部队医院收治的经中心静脉穿刺置管治疗严重创伤失血性休克的128例患者进行研究,采用随机数表法分为观察组(64例,急诊超声评估下液体复苏法)与对照组(64例,常规体液复苏法)。比较两组患者液体复苏情况和穿刺成功率。结果:液体复苏1 h,两组患者心率(HR)、平均动脉压(MAP)、尿量、氢离子浓度指数(pH)、碱剩余(BE)、乳酸(Lac)水平比较,差异无统计学意义(P>0.05);液体复苏24 h,观察组患者HR、Lac显著低于对照组,MAP、尿量、pH、BE显著高于对照组,差异具有统计学意义(P<0.05)。复苏24 h后,观察组患者补液量、药物应用时间显著低于对照组,乳酸清除率、组织血氧饱和度(StO_(2))显著高于对照组,差异具有统计学意义(P<0.05)。观察组患者一次穿刺成功率、总体穿刺成功率显著高于对照组,差异具有统计学意义(P<0.05)。结论:急诊超声对创伤失血性休克患者的液体复苏具有较好的评估价值,可作为对患者病情预测的方法。

Objective To analyze the clinical application value of emergency ultrasound in the evaluation and treatment of patients with severe traumatic hemorrhagic shock.Methods From January 2019 to December 2020,128 patients with severe traumatic hemorrhagic shock treated by central venipuncture in the 91811 Army Hospital of the Chinese People’s Liberation Army were selected for the study,and they were divided into the observation group(64 Cases,fluid resuscitation under emergency ultrasound evaluation)and the control group(64 cases,conventional fluid resuscitation by random number table method).The fluid resuscitation and the success rate of puncture were compared between the two groups.Results After 1 hour of fluid resuscitation,there was no statistically significant difference in heart rate(HR),mean arterial pressure(MAP),urine output,pH,alkaline excess(BE),and lactic acid(Lac)levels between the two groups of patients(P>0.05);fluid resuscitation for 24 hours,the HR and Lac of the observation group were significantly lower than those of the control group,and the MAP,urine output,pH,and BE were significantly higher than those of the control group,the differences were statistically significant(P<0.05).After 24 hours of resuscitation,the amount of fluids and drug application time in the observation group were significantly lower than those in the control group,and the lactic acid clearance rate and tissue oxygen saturation(StO_(2))were significantly higher than those in the control group.The differences were statistically significant(P<0.05).The one-time puncture success rate and overall puncture success rate of the observation group were significantly higher than those of the control group,and the differences were statistically significant(P<0.05).Conclusion Emergency ultrasound has better evaluation value for fluid resuscitation in patients with traumatic hemorrhagic shock and can be used as a method to predict the condition of patients.