液体复苏对创伤失血性休克患者血细胞比容血清乳酸和预后的影响

Effects of Fluid Resuscitation on Hematocrit,Serum Lactic Acid and Prognosis of Patients with Traumatic Hemorrhagic Shock

目的:研究不同液体复苏模式对创伤失血性休克患者血细胞比容(HCT)、血清乳酸(BLA)以及预后的影响。方法:回顾性分析我院2017年1月至2021年11月收治的184例创伤失血性休克患者的临床资料。根据液体复苏模式分为观察组和对照组,每组92例,其中对照组患者使用传统限制性液体复苏,观察组患者B超测下腔静脉变异度指导液体复苏,比较两组患者输液量、输血量、重症监护室(ICU)住院时间、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、HCT以及BLA,并分析两组患者住院期间的预后情况。结果:观察组患者的输液量、输血量和ICU住院时间均低于对照组患者(P<0.05);观察组患者复苏后1h时的PT、APTT和BLA低于对照组患者(P<0.05),HCT高于对照组患者(P<0.05);观察组患者住院期间7例患者发生多器官综合征(MODS),6例患者发生急性呼吸窘迫综合征(ARDS),3例患者病死,对照组患者住院期间10例患者发生MODS,9例患者发生ARDS,7例患者病死,两组患者的MODS发生率、ARDS发生率以及病死率差异无统计学意义(P>0.05)。结论:B超测下腔静脉变异度指导液体复苏操作简便、无创,监测指标较精确,相比于传统限制性复苏,可以有效降低患者发生凝血功能障碍及其他并发症的风险。

Objective:To study the effects of different fluid resuscitation modes on hematocrit(HCT),serum lactic acid(BLA)and prognosis of patients with traumatic hemorrhagic shock.Methods:The clinical data of 184 patients with traumatic hemorrhagic shock admitted to the hospital between January 2017~November 2021 were retrospectively analyzed.According to the fluid resuscitation mode,they were divided into observation group and control group,with 92 cases in each group.Patients in the control group were treated with conventional limited fluid resuscitation,and patients in the observation group were treated with B-ultrasound monitored inferior vena cava variability guided fluid resuscitation.The fluid infusion volume,blood transfusion volume,length of intensive care unit(ICU)stay,prothrombin time(PT),activated partial thromboplastin time(APTT),HCT and BLA level were compared between the 2 groups,and prognosis of the 2 groups was analyzed.Results:The fluid infusion volume,blood transfusion volume and ICU stay of the observation group were significantly smaller/shorter than those of the control group(P<0.05).1h after resuscitation,PT,APTT and BLA level of the observation group were significantly shorter/lower than those of the control group(P<0.05),and HCT was significantly higher than that of the control group(P<0.05).In the observation group,7 patients developed multiple organ dysfunction syndrome(MODS),6 patients developed acute respiratory distress syndrome(ARDS),and 3 patients died during hospitalization.In the control group,10 patients developed MODS,9 patients developed ARDS,and 7 patients died during hospitalization.There were no significant differences in the incidence rates of MODS,ARDS and death between the 2 groups(P>0.05).Conclusion:B-ultrasound monitored inferior vena cava variability guided fluid resuscitation is simple to operate,and the monitoring indicators are more accurate.Compared with conventional limited fluid resuscitation,it can reduce the risks of coagulation dysfunction and other complications.