碳酸氢钠林格液在创伤性肝脾破裂伴失血性休克早期复苏中对炎症因子及乳酸水平的影响

Application of sodium bicarbonate ringer’s solution in early resuscitation of traumatic hepatosplenic rupture with hemorrhagic shock

目的 探讨碳酸氢钠林格液在创伤性肝脾破裂伴失血性休克患者进行限制性复苏对炎症因子及乳酸水平的影响。方法 收集就诊于六安市人民医院急诊科60例创伤性肝脾破裂伴失血性休克病人,采用随机数据表法分为对照组和观察组,各30例。两组均采用限制性液体复苏,分别用乳酸钠林格液和碳酸氢钠林格液对两组进行复苏。在复苏前、复苏1 h后检测患者静脉血清中IL-6、TNF-α水平以及动脉血的乳酸值。结果 观察组IL-6、TNF-α水平在复苏1 h后均较复苏前明显下降,差异具有统计学意义(P<0.01),而对照组复苏1 h后IL-6、TNF-α水平较复苏前升高,差异具有统计学意义(P<0.01)。复苏1 h后,观察组中IL-6和TNF-α水平明显低于对照组,差异具有统计学意义(P<0.01)。复苏1 h后,观察组乳酸水平显著低于对照组,差异具有统计学意义(P<0.01);在观察组中复苏1h后乳酸水平明显下降,差异具有统计学意义,对照组在复苏前后比较差异不明显(P>0.05)。结论 应用碳酸氢钠林格液能更好地抑制创伤性肝脾破裂伴失血性休克患者外周血中炎症因子的表达,并且能够有效的纠正酸中毒,比乳酸钠林格液复苏效果更加理想。

Objective To investigate the effects of Sodium Bicarbonate Ringer’s Solution on inflammatory factors and lactate levels in patients with traumatic rupture of liver and spleen with hemorrhagic shock undergoing restrictive resuscitation.Methods 60 cases with traumatic rupture of liver and spleen with hemorrhagic shock in the emergency department of Lu’an People’s Hospital were randomly divided into control group and observation group,with 30 cases in each group.Both groups were resuscitated with restricted fluid,and the two groups were resuscitated with Sodium Lactate Ringer’s Solution and Sodium Bicarbonate Ringer’s Solution respectively.Before resuscitation and 1 hour after resuscitation,the levels of interleukin-6(IL-6) and tumor necrosis factor α(TNF-α) in venous serum and the lactate value in arterial blood were measured.Results The levels of IL-6 and TNF-α in the observation group were significantly lower after 1 hour of resuscitation than before resuscitation(P<0.01),the difference was statistically significant,while the levels of IL-6 and TNF-α in the control group increased after 1 h of resuscitation than before resuscitation(P<0.01),there was significant difference.One hour after resuscitation,the levels of IL-6 and TNF-α in the observation group were significantly lower than those in the control group(P<0.01).After 1 hour of resuscitation,the level of lactic acid was significantly lower comparing between observation group and control group(P<0.01);in the observation group,the lactic acid level decreased significantly after 1 hour of resuscitation,and the difference was statistically significant.There was no significant difference in the control group between before and after resuscitation(P>0.05).Conclusion The application of Sodium Bicarbonate Ringer’s Solution can better inhibit the expression of inflammatory factors in the peripheral blood of patients with traumatic rupture of liver and spleen with hemorrhagic shock,and can effectively correct acidosis,which is more ideal than the resuscitation effect of Sodium Lactate Ringer’s Solution.