高渗盐液体复苏、限制性液体复苏及常规液体复苏在创伤失血性休克中的应用效果比较

摘要

Objective To compare the application effects by applying hypertonic saline fluid resuscitation, limited fluid resuscitation and conventional fluid resuscitation in traumatic hemorrhagic shock. Methods A total of 76 patients with traumatic hemorrhagic shock were divided by different treatment methods into group A (25 cases), group B (29 cases) and group C (22 cases), and they respectively received hypertonic saline fluid resuscitation, limited fluid resuscitation and conventional fluid resuscitation. Comparisons were made on mortality rate, average infusion quantity, renal function, incidence of complications, and related laboratory index of the three groups. Results The difference of mortality rates across the three groups within 24 h had no statistical significance (P>0.05). The group C had much higher 1 week mortality rate than group A and group B (P<0.05);the group C had much higher incidence of complications than group A and group B (P<0.05);and average infusion quantity were higher in group C than in group A and group B (P<0.05). Group A and group B had better hemoglobin (HBG), platelets (PLT), prothrombin time (PT), and activated partial thromboplastin time (APTT) (P<0.05). After resuscitation, group A and group B had remarkably lower blood urea nitrogen (BUN) and creatinine (Scr) than group C (P<0.05);and group A and group B had much better left ventricular ejection fraction (LVEF) than group C (P<0.05). Conclusion Compared with conventional fluid resuscitation, hypertonic saline fluid resuscitation and limited fluid resuscitation in treating traumatic hemorrhagic shock can effectively improve clinical outcome.%目的：比较高渗盐液体复苏、限制性液体复苏及常规液体复苏在创伤失血性休克中的应用效果。方法76例创伤失血性休克患者根据治疗方法的不同分为A组(25例)、B组(29例)、C组(22例)三组,分别接受高渗盐液体复苏、限制性液体复苏及常规液体复苏。比较三组死亡率、平均输液量、肾功能、并发症发生率、相关实验室指标的差别。结果三组24 h内死亡率差异无统计学意义(P>0.05),1周内C组死亡率显著高于A组及B组(P<0.05)；C组并发症发生率显著高于A组及B组(P<0.05)；C组平均输液量显著多于B组及A组(P<0.05)；A组、B组血红蛋白(HBG)、血小板(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)显著优于C组(P<0.05)；复苏后A组及B组尿素氮(BUN)及肌酐(Scr)显著低于C组(P<0.05)；A组与B组复苏后左室射血分数(LVEF)显著优于C组(P<0.05)。结论与常规液体复苏相比,高渗盐液体复苏及限制性液体复苏治疗创伤失血性休克更有利于改善患者临床结局。