血浆和红细胞不同输注比率在重型颅脑损伤合并严重多发伤救治中的疗效观察

摘要

目的 探讨给予不同的新鲜冰冻血浆和红细胞输注比率对救治重型颅脑损伤合并严重多发伤的临床疗效.方法 回顾性分析我院急诊科2001年1月~2010年12月救治的420例严重多发伤需要大量液体复苏患者的临床资料,分为合并颅脑损伤组(206例)和无颅脑损伤组(214例),根据给予新鲜冰冻血浆(FFP)和红细胞(RBC)的比率,再分为高比率组(FFP:RBC＞1:2)和低比率组(FFP:RBC≤1:2).比较两组患者病死率,脓毒血症、多器官功能障碍综合征(MODS)的发生率,以及脱机时间、ICU治疗时间和住院时间.结果 不论是否合并有颅脑损伤,高比率组的病死率低于低比率组,有统计学意义(P＜0.001);合并颅脑损伤的高比率组脓毒症的发生率较高(P＜0.05),其他各组脓毒症和多器官功能衰竭的发生率没有差别;高比率组和低比率组的脱机时间、ICU治疗时间、住院时间有明显差别,但是在存活患者中,两组没有差别.结论 重型颅脑损伤合并严重多发伤需要大量液体复苏的患者,早期液体复苏给予高比率的FFP和RBC可以降低死亡率.%Objective To compare the curative effect of different treatments for flail chest, optimize the therapeutic strategies. Methods The clinical data of 69 patients with flail chest in our hospital from 2005 to 2010 were studied retrospectively. The patients were divided into: group A ( pressure dressing group) with 30 cases, group B (respirator group) with 21 cases and group C ( surgical fixation group) with 18 cases. Indicators of three different treatments were compared. It was considered statistically significant when P<0. 05. Results Compared with group A,patients in group B indicated remarkable improvement of respiratory and circulation indicators( P < 0.001) ,higher incidence of pneumonia (P<0.05) ,lower incidence of chest deformity and vasoactive drugs utilization! P< 0.05),shorter ICU stay and total hospital stay( P <0. 05 ) . Compared with group A and group C, indicators of breath and circulation were obviously improved(P < 0. 001),there was statistical difference in incidence of pneumonia,chest deformity and vasoactive drugs utilization ( P < 0. 05 ) , ICU stay and total hospital stay ( P < 0.05). Compared with group B and group C,there was no statistical difference in RR,PaO2 ,PaCO2 ( P > 0. 05) , but statistical difference in incidence of pneumonia,chest deformity and vasoactive drugs utilization ( P <0. 05) ,ICU stay and total hospital stay(P<0. 05),indicators of circulation (P<0.05). Patients in group C were found quick lung function recovery. There was no statistical difference in incidence of death of three groups. Conclusion Surgical intervention rapidly stabilizes the chest wall,impels stability of breath and circulation,reduces complications.