限制性液體復蘇在嚴重多發傷導致失血性休克中的 作用探討

?謝偉山 伍運輝 吳向前 駱強

【摘要】 目的：探討嚴重的多發傷造成失血性休克患者應用限制液體復蘇治療效果情況。方法：選取2017年12月-2018年12月筆者所在醫院診治的100例嚴重的多發傷并失血性休克患者，隨機分兩組，對照組予常規積極液體相關復蘇治療，研究組予限制液體復蘇治療方案，分析兩組復蘇指標及GCS指標、凝血指標及并發癥情況。結果：治療后，研究組液體輸入（1620.54±651.23）ml，術前復蘇時間（62.23±10.46）min，均比對照組少，GCS評分（9.81±1.06）分，比對照組高，差異有統計學意義（P<0.05）;研究組PT（13.06±1.23）s、APTT（21.23±1.46）s及TT（12.13±1.26）s，均比對照組低，差異有統計學意義（P<0.05）;研究組發生呼吸衰竭、炎癥反應等并發癥均比對照組少，比較差異有統計學意義（P<0.05）。結論：嚴重的多發傷并失血性休克患者應用限制性相關液體復蘇治療，能改善患者復蘇指標及GCS評分，改善凝血指標，并減少并發癥發生。

【關鍵詞】 嚴重多發傷; 失血性休克; 限制液體復蘇; 凝血指標; 復蘇指標

doi：10.14033/j.cnki.cfmr.2019.12.014 文獻標識碼 B 文章編號 1674-6805（2019）12-00-03

The Role of Restrictive Fluid Resuscitation in Severe Hemorrhagic Shock Caused by Hemorrhagic Shock/XIE Weishan，WU Yunhui，WU Xiangqian，et al.//Chinese and Foreign Medical Research，2019，17（12）：-34

【Abstract】 Objective：To explore the role of restrictive fluid resuscitation in severe hemorrhagic shock caused by hemorrhagic shock.Method：100 patients with severe multiple trauma and hemorrhagic shock were diagnosed and treated in our hospital from December 2017 to December 2018，which were randomly divided into two groups.The control group received routine active fluid-related resuscitation，and the study group restricted fluid resuscitation.Then analyzed the recovery indicators and GCS indicators，coagulation indicators and complications of two groups.Result：After treatment，the fluid input （1 620.54±651.23）ml and preoperative resuscitation （62.23±10.46）min in the study group were lower than those in the control group，and the GCS （9.81±1.06）points was higher than that of the control group（P<0.05）.The PT （13.06±1.23）s，APTT （21.23±1.46）s and TT （12.13±1.26）s in the study group were lower than those in the control group，and the difference was statistically significant（P<0.05）.The operative complications，respiratory failure and inflammatory reaction in the study group were less than those in the control group，and the difference was statistically significant（P<0.05）.Conclusion：The patients with severe multiple trauma and hemorrhagic shock treated with restrictive fluid resuscitation could improve the recovery index and GCS index，reduce the coagulation index，and has fewer complications.

【Key words】 Severe multiple injuries; Hemorrhagic shock; Limited fluid resuscitation; Coagulation index; Recovery index

First-authors address：Houjie Hospital of Dongguan City，Dongguan 523000，China

多發傷主要指同致傷因素下造成機體出血超過一個部位嚴重創傷，并且多發傷患者機體臟器、組織損傷比較嚴重，會造成大量失血，進而出現失血性休克，嚴重影響患者正常生活質量[1-2]。臨床通常采用液體復蘇治療方案，以維持機體生命體征穩定，恢復血壓及器官灌注，降低失血造成的負面影響[3-4]。為提高患者急救效果，本研究對2017年12月-2018年12月筆者所在醫院診治的50例嚴重的多發傷并失血性休克患者應用限制液體復蘇治療效果進行分析，具體報告如下。