醋酸林格氏液自体血液回收在失血性休克患者急诊手术中的应用

摘要

目的:探讨醋酸林格氏液自体血液回收在失血性休克患者急诊手术中的应用效果及护理配合要点.方法:对2007-11-2010-11我院失血性休克急诊手术病例119例,随机分成观察组60例和对照组59例,观察组在自体血液回输前应用醋酸林格氏液1000ml,对照组在自体血液回输前应用乳酸林格氏液1000ml,比较术后2h心率、血压及毛细血管充盈时间与24 h红细胞、血红蛋白、血乳酸水平和肝功能的的变化.结果:119例患者手术顺利,无1例患者出现输血反应和其他并发症,术后2h、24 h红细胞(RBC)、血红蛋白(HGB)、血压(BP)比术前明显增高(P＜0.05).心率比术前明显降低(P＜0.05),毛细血管充盈时间比术前明显缩短(P＜0.05).观察组24小时后血乳酸和肝功能与术前无明显差异,对照组血乳酸水平明显增高,肝功能也有较明显的变化,和观察组比较差异有统计学意义(P＜0.01).结论:自体血液回收在失血性休克急诊手术中的应用安全有效,节约了血源.醋酸林格氏液在救治低血容量性休克中优于乳酸林格氏液,且对血小板和肝功能具有较好的保护作用.%Objective: To investigate the application and nursing of Acetated Ringer's solution in patients with acute haemorrhagic shock receiving emergency operation. Method: 119 cases of acute hemorrhagic shock patients receiving emergency operation from Nov. 2007 to Nov. 2010 in our hospital were enrolled in this study. They were random divided into two groups; 60 cases of the experimental group (1000 ml Acetated Ringer's solution infused before autologous blood transfusion) and 59 cases of the control group (1000 ml Lactated Ringer's solution infused before autologous blood transfusion). RBC, HGB, HR, BP and capillary refill times at 2 h and the change of red blood cells, hemoglobin, the level of lactic acid in blood and the liver function at 24 h were compared after operation. Result: All patients were operated successfully without blood transfusion reaction and other complications. The RBC, HGB, BP at 2 h and 24 h after operation were significantly increased (P<0. 05 ) , the HR was significantly decreased (P<0. 05) , and the capillary refill times were significantly shortened compared with preop-erative phase(P<0. 05). The level of lactic acid in blood and the liver function at 24 h had no difference after operation in the experimental group, but the control group were significantly increased (P<0. 01). Conclusion: Autologous blood transfusion is safe and effective in the emergency operation of acute hemorrhagic shock. Acetated Ringer's solution is better than Lactated Ringer's solution in the treatment of hypovolemic shock. It has a better protection for platelets and hepatic function.