失血性休克患者的液体复苏策略探讨

摘要

ObjectiveTo discuss the best fluid resuscitation method of hemorrhagic shock.MethodsFrom June 2012 to June 2014 in our hospital 90 cases of patients with hemorrhagic shock were chosen and randomly divided into two groups according to random number method: the observation group(50 cases)having restrictive fluid resuscitation,and the control group(40 cases)given regular fluid resuscitation; Blood coagulation function,fatality rate and complications rate of the two groups were observed and compared.ResultsThe infusion quantity of the observation group was[(1285±342)ml]lower than the control group’s[(2890±456)ml](P<0.05); The input plasma amount of the two groups were(501±331)ml and(498±231)ml respectively,which had no statistically significant difference(P>0.05). The observation group’s cure rate was 90% and its death rate was 10%,significantly higher than the control group’s cure rate 72.5% and the mortality rate 27.5%(P<0.05). Maintain group MAP of the observation group was 40 ~ 60 mmHg,(51.4±8.9)mmHg on average while that of the control group was 60 ~ 80 mmHg,(67.2±9.1)mmHg on average; Two groups of patients' HBG,HCT,PLT,PT and BE differences after recovery were all statistically significant(P<0.05). The observation groups’ ARDA and MODS incidence of were 9.1% and 12% separately,significantly lower than the control group’s 25% and 30% respectively(P<0.05); The incidences of AKI in the two groups were 12% and 12.5% respectively,without significant difference(P>0.005).Conclusions Restrictive fluid resuscitation is beneficial to win time for subsequent operation rescue,which could also reduce the mortality of uncontrolled hemorrhagic shock and the incidence of complications such as ARDS and MODS,worthy of clinical promotion.%目的：对失血性休克的最佳液体复苏方法进行探讨。方法选取2012年6月至2014年6月失血性休克患者90例，将其按照随机数字法随机分为两组，其中限制性液体复苏（观察组）50例，常规液体复苏（对照组）40例，观察不同液体复苏方法对患者病死率、凝血功能及并发症的影响。结果观察组输液量[（1285±342）ml]低于对照组[（2890±456）ml]（P<0.05）；两组输入血浆量分别为（501±331）ml、（498±231）ml，差异均无统计学意义（P>0.05）。观察组治愈率90%，病死率10%，对照组治愈率72.5%，病死率27.5%，差异均有统计学意义（P<0.05）。观察组MAP维持在40~60mmHg，平均（51.4±8.9）mmHg；对照组维持在60~80mmHg，平均（67.2±9.1）mmHg；两组患者复苏后HBG、HCT、PLT、PT、BE差异均有统计学意义（P均<0.05）。观察组ARDS的发生率9.1%低于对照组的25%，MODS发生率12%显著性低于对照组30%，差异均有统计学意义（P<0.05）；两组AKI发生率分别为12%、12.5%，差异无统计学意义（P>0.05）。结论限制性液体复苏有利于为后续的手术抢救赢得时间，可降低失血性休克的病死率及ARDS、MODS等并发症的发生率，值得临床推广。