下腔静脉变异指导液体复苏对创伤失血性休克患者血栓弹力图、炎症因子的影响及预后相关分析

The influence of fluid resuscitation guided by inferior vena cava variation on thrombus elasmogram,inflammatory factors and prognostic correlation in patients with traumatic hemorrhagic shock

目的探讨基于B超的下腔静脉变异指导液体复苏模式对创伤失血性休克患者血栓弹力图、炎症因子的影响及不同液体复苏模式与患者预后的联系。方法选取2020年1月—2022年6月我院收治的创伤失血性休克患者104例,依据随机数表法将其分为对照组和观察组,每组52例。对照组接受常规限制性液体复苏,观察组接受基于B超的下腔静脉变异指导液体复苏。比较两组患者临床资料、血栓弹力图指标[凝血反应时间(R),血凝块形成时间(K)、血凝块最大强度]、炎症因子[肿瘤坏死因子α(TNF-α)、白介素-6(IL-6)、IL-10]差异。根据104例患者28 d内死亡、多器官功能障碍综合征、急性呼吸窘迫综合征发生情况分为为预后不良组(n=23)和预后良好组(n=81)。采用二元Logistics回归分析影响预后的因素,探究不同液体复苏模式与预后的联系。结果与对照组比较,观察组患者输液量、输血量、ICU住院时间更少(P<0.05);干预1 h,R、K更低,血凝块最大强度更大(P<0.05);干预1 h,TNF-α、IL-6、IL-10更低(P<0.05)。与预后良好组相比,预后不良组患者发病至入院时间≥6 h、限制性液体复苏占比更大,休克指数、ISS评分更高(P<0.05)。以发病至入院时间(<6 h=1,≥6 h=0)、液体复苏模式(下腔静脉变异指导=1,限制性液体复苏=0)、休克指数、ISS评分为自变量,预后(预后不良=1,预后良好=0)为因变量,二元Logistics回归分析显示液体复苏模式、发病至入院时间、ISS评分是影响预后不良的因素(P<0.05)。结论基于B超的下腔静脉变异指导液体复苏可提升患者康复与治疗效率,改善血栓弹力图、炎症反应,是改善预后的保护性因素。

Objective To analyze the effects of fluid resuscitation mode guided by the variation of inferior vena cava based on B-ultrasound on thrombus elasmogram and inflammatory factors in patients with traumatic hemorrhagic shock,and explore the relationship between different fluid resuscitation modes and the prognosis of patients.Methods A total of 104 patients with traumatic hemorrhagic shock admitted to our hospital from January 2020 to June 2022 were selected and divided into control group(52 cases)and observation group(52 cases)according to random number table method.The control group received conventional limited fluid resuscitation,and the observation group received fluid resuscitation guided by B-ultrasound of inferior vena cava variation.The differences of clinical data,thromboelastogram indexes[coagulation reaction time(R),blood clot formation time(K),maximum clot intensity],inflammatory factors[tumor necrosis factorα(TNF-α),interleukin-6(IL-6),and IL-10]between the two groups were compared.According to the occurrence of death,multiple organ dysfunction syndrome and acute respiratory distress syndrome within 28 days,104 patients were divided into poor prognosis group(23 cases)and good prognosis group(81 cases).The factors affecting prognosis were analyzed by binary logistics regression to explore the relationship between different fluid resuscitate modes and prognosis.Results Compared with the control group,the amount of infusion,blood transfusion and ICU stay in the observation group were less(P<0.05).Compared with the control group,R and K were lower and the maximum blood clot intensity was higher in the observation group at 1 h(P<0.05).Compared with the control group,the TNF-α,IL-6 and IL-10 in the observation group were lower at 1 h after intervention(P<0.05).Compared with the good prognosis group,the time from onset to admission was≥6 h,the proportion of restricted fluid resuscitation,the shock index and ISS score were higher in the poor prognosis group(P<0.05).Time from onset to admission(<6 h=1,≥6 h=0),fluid resuscitation mode(guidance for inferior vena cava variation=1,restricted fluid resuscitation=0),shock index and ISS score were independent variables,and prognosis(poor prognosis=1,good prognosis=0)were dependent variables.Dualistic logistics regression analysis showed that fluid resuscitation mode,time from onset to hospital admission and ISS score were the factors influencing poor prognosis(P<0.05).Conclusion Guided fluid resuscitation based on B-ultrasound for inferior vena cava variation can improve patient rehabilitation and treatment efficiency,improve thromboelastography and inflammatory response,and is a protective factor for poor prognosis of patients.