限制性液体复苏联合体温管理对多发伤伴失血性休克患者低体温及应激反应的影响

Effects of restrictive fluid resuscitation combined with body temperature management on hypothermia and stress response in patients with multiple trauma and hemorrhagic shock

目的分析限制性液体复苏联合体温管理对多发伤伴失血性休克患者低体温及应激反应的影响。方法选择我院2020年1月至12月收治的80例多发伤伴失血性休克患者作为研究对象,以治疗方案差异将其分为常规组和观察组,每组40例。常规组给予传统液体复苏联合体温管理治疗,观察组给予限制性液体复苏联合体温管理治疗。比较两组的治疗效果。结果观察组的不良事件总发生率显著低于常规组(P<0.05)。入院时,两组的肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)、皮质醇(Cor)、超氧化物歧化酶(SOD)及丙二醛(MDA)水平无明显差异(P>0.05);复苏时、复苏2 h后,观察组的TNF-α、IL-8、Cor及MDA水平低于常规组,IL-10、SOD水平高于常规组(P<0.05)。入院时,两组的凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、心排血量(CO)、心排血指数(CI)及全心舒张末期容积指数(GEDVI)无明显差异(P>0.05);复苏时、复苏2 h后,观察组的TT、PT及APTT短于常规组,CO、CI及GEDVI高于常规组(P<0.05)。结论限制性液体复苏联合体温管理可有效缩短多发伤伴失血性休克患者的复苏时间,降低不良事件发生率,并快速缓解炎症、应激反应,促进心功能恢复。

Objective To analyze the effects of restrictive fluid resuscitation combined with body temperature management on hypothermia and stress response in patients with multiple trauma and hemorrhagic shock.Methods A total of 80 patients with multiple trauma and hemorrhagic shock admitted in our hospital from January to December 2020 were selected as the research objects.According to the difference of treatment plan,the patients were divided into conventional group and observation group,with 40 cases in each group.The conventional group was treated with traditional fluid resuscitation combined with body temperature management,and the observation group was treated with restrictive fluid resuscitation combined with body temperature management.The therapeutic effects of the two groups were compared.Results The total incidence of adverse events in the observation group was significantly lower than that in the conventional group(P<0.05).On admission,there were no significant differences in the levels of tumor necrosis factor-α(TNF-α),interleukin-8(IL-8),interleukin-10(IL-10),cortisol(Cor),superoxide dismutase(SOD)and malondialdehyde(MDA)between the two groups(P>0.05);at the time of resuscitation and 2 h after resuscitation,the levels of TNF-α,IL-8,Cor and MDA in the observation group were lower than those in the conventional group,and the levels of IL-10 and SOD were higher than those in the conventional group(P<0.05).On admission,there were no significant differences in thrombin time(TT),prothrombin time(PT),activated partial thromboplastin time(APTT),cardiac output(CO),cardiac index(CI)and global end diastolic volume index(GEDVI)between the two groups(P>0.05);at the time of resuscitation and 2 h after resuscitation,TT,PT and APTT in the observation group were shorter than those in the conventional group,CO,CI and GEDVI were higher than those in the conventional group(P<0.05).Conclusion Restrictive fluid resuscitation combined with body temperature management can effectively shorten the recovery time of patients with multiple trauma and hemorrhagic shock,reduce the incidence of adverse events,quickly relieve inflammation and stress response,and promote the recovery of cardiac function.