限制性補液療法在搶救產后出血失血性休克患者中的應用

沙小龍+王倩

【摘要】 目的：討論對產后出血失血性休克患者采取限制性補液法進行搶救的優勢。方法：選取2012年1月-2013年5月本院所搶救產后出血休克患者82例，采取傳統補液法和限制性補液法，對比兩種方法搶救失血性休克的相關指標的差異。結果：限制性補液組的實驗室指標如血紅蛋白、紅細胞壓積、血小板明顯高于傳統補液組，凝血時間以及D-二聚體低于傳統補液組；且總共失血量、輸液量、輸血量、行子宮切除術率以及發生DIC及MODS幾率均低于傳統補液組。結論：限制性補液能避免大量輸液引起稀釋性凝血功能障礙，減少持續出血；能改善重要臟器灌注，增強組織供氧，盡可能減少并發癥發生，改善預后，對搶救產后出血失血性休克患者有明顯優勢。

【關鍵詞】 限制性補液； 產后出血； 失血性休克

Restrictive Fluid Therapy in the Treatment of Postpartum Hemorrhage in Patients with Hemorrhage Shock/SHA Xiao-long， WANG Qian.//Medical Innovation of China，2014，11（28）：056-058

【Abstract】 Objective： To explore the advantages of restrictive fluid therapy in the treatment of postpartum hemorrhage in patients with hemorrhage shock. Method： 82 patients with postpartum hemorrhage in our hospital from Jan 2012 to May 2013 randomly taken the method of traditional infusion or limited fluid resuscitation， and the differences of indexes between the two methods were compared to rescue the hemorrhagic shock. Result： Laboratory such as hemoglobin index fluid resuscitation group Limited， hematocrit， platelet was significantly higher than that of conventional resuscitation group， blood coagulation time and D-two dimmer was lower than that of the conventional resuscitation group， and the total blood loss， volume of transfusion， blood transfusion， hysterectomy rates and DIC and MODS were lower than that of the conventional resuscitation group probability. Conclusion： Limited fluid resuscitation can avoid a lot of caused by intravenous infusion of dilutional coagulopathy， reduce the continuous hemorrhage， can improve perfusion of important organs， increase tissue oxygen supply， as far as possible to reduce the incidence of complications， improve the prognosis of postpartum hemorrhage， hemorrhagic shock patients have obvious advantages.

【Key words】 Limited fluid resuscitation； Postpartum hemorrhage； Hemorrhagic shock

First-authors address： Maternal and Child Health Hospital， Xuzhou 221009， China

doi：10.3969/j.issn.1674-4985.2014.28.020

產后出血為分娩期嚴重并發癥，居我國產婦死亡原因首位。因快速大量失血導致的有效循環血量減少，全身組織器官灌注不足，機體內環境穩態破壞，繼發微循環障礙，組織無氧代謝引起酸中毒，血管收縮細胞損傷而產生的臨床綜合征稱為失血性休克。若未能及時糾正，可演變為多器官功能障礙綜合征（MODS）甚至導致死亡。休克的本質為急性大量失血后有效循環血量不足引起組織灌注不足，最終引起多臟器功能衰竭。傳統上主張盡快盡早恢復組織灌注，快速大量補液，使血壓恢復正常水平。但臨床上發現大量快速液體輸入可影響機體的保護性凝血機制，使已形成的血栓脫落，局部壓差拉大，血管保護性痙攣解除，稀釋了血液中的凝血因子，加重出血，以致復蘇后的并發癥以及病死率明顯增加[1]?！?br>