有潜在再出血风险低血容量性休克患者的液体复苏目标研究

摘要

Objective To investigate reasonable fluid resuscitation target for hypovolemic shock patients with potential risk of rebleeding. Methods We enrolled 48 patients with hemorrhagic shock who were admitted into Tianjin Medical University General Hospital from April 2011 to April 2014 and randomly assigned them into observation group( fluid resuscitation target:MAP 55-65 mm Hg and SBP ﹤95 mm Hg;1 mm Hg=0. 133 kPa;n=26)and control group(MAP 66-75 mm Hg and SBP﹤105 mm Hg;n=22). Before fluid infusion,and 12 h,24 h,48 h,72 h after infusion,a series of date were recorded, including level of extravascular lung water( EVLW)and blood lactic acid,length of ICU stay,time to reach fluid negative balance,rebleeding,multiple organ dysfunction syndrome( MODS)and acute respiratory distress syndrome( ARDS)and 28 day mortality. ResuIts The level of EVLW and blood lactic acid was different between two groups(P﹤0. 05). Compared with control group,observation group had shorter length of ICU stay(8. 7 d vs. 11. 3 d,t=2. 813,P﹤0. 05)and time to reach negative fluid balance(5. 2 d vs. 6. 9 d,t =2. 036,P ﹤0. 05). Compared with control group,observation group had lower incidence of rebleeding(15. 4% vs. 40. 9%,χ2 =3. 931,P﹤0. 05),MODS(15. 4% vs. 45. 5%,χ2 =5. 215,P﹤0. 05) and ARDS(11. 5% vs. 36. 4%,χ2 =4. 157,P﹤0. 05). ConcIusion The fluid resuscitation target of MAP of 55 -65 mm Hg and SBP less than 95 mm Hg is safe,reasonable and effective for hypovolemic shock patients with potential risk of rebleeding.%目的：探讨有潜在再出血风险低血容量性休克患者的合理液体复苏目标。方法选取2011年4月—2014年4月天津医科大学总医院收治的失血性休克患者48例为研究对象，以随机数字表法将患者分为观察组〔复苏目标：平均动脉压55~65 mm Hg（1 mm Hg＝0.133 kPa），收缩压﹤95 mm Hg，26例〕和对照组（复苏目标：平均动脉压66~75 mm Hg，收缩压﹤105 mm Hg，22例）。记录患者补液前及补液后12、24、48、72 h血管外肺水（ EVLW）及血乳酸水平，ICU住院时间、达液体负平衡时间，再出血、多器官功能障碍综合征（ MODS）、急性呼吸窘迫综合征（ ARDS）发生率及28 d死亡情况。结果两组EVLW及血乳酸水平比较，差异有统计学意义（ P﹤0.05）。观察组ICU住院时间、达液体负平衡时间分别为8.7、5.2 d，与对照组11.3、6.9 d 比较，差异均有统计学意义（ t ＝2.813、2.036，P﹤0.05）。观察组再出血、MODS、ARDS 发生率分别为15.4%、15.4%和11.5%，低于对照组的40.9%、45.5%和36.4%，差异有统计学意义（χ2＝3.931、5.215、4.157，P﹤0.05）。结论将平均动脉压控制在55~65 mm Hg且收缩压﹤95 mm Hg范围内，对于有潜在再出血风险的低血容量性休克患者是合理、安全、有效的。