限制性液体复苏在严重多发伤导致失血性休克中的 作用探讨

?谢伟山 伍运辉 吴向前 骆强

【摘要】 目的：探讨严重的多发伤造成失血性休克患者应用限制液体复苏治疗效果情况。方法：选取2017年12月-2018年12月笔者所在医院诊治的100例严重的多发伤并失血性休克患者，随机分两组，对照组予常规积极液体相关复苏治疗，研究组予限制液体复苏治疗方案，分析两组复苏指标及GCS指标、凝血指标及并发症情况。结果：治疗后，研究组液体输入（1620.54±651.23）ml，术前复苏时间（62.23±10.46）min，均比对照组少，GCS评分（9.81±1.06）分，比对照组高，差异有统计学意义（P<0.05）;研究组PT（13.06±1.23）s、APTT（21.23±1.46）s及TT（12.13±1.26）s，均比对照组低，差异有统计学意义（P<0.05）;研究组发生呼吸衰竭、炎症反应等并发症均比对照组少，比较差异有统计学意义（P<0.05）。结论：严重的多发伤并失血性休克患者应用限制性相关液体复苏治疗，能改善患者复苏指标及GCS评分，改善凝血指标，并减少并发症发生。

【关键词】 严重多发伤; 失血性休克; 限制液体复苏; 凝血指标; 复苏指标

doi：10.14033/j.cnki.cfmr.2019.12.014 文献标识码 B 文章编号 1674-6805（2019）12-00-03

The Role of Restrictive Fluid Resuscitation in Severe Hemorrhagic Shock Caused by Hemorrhagic Shock/XIE Weishan，WU Yunhui，WU Xiangqian，et al.//Chinese and Foreign Medical Research，2019，17（12）：-34

【Abstract】 Objective：To explore the role of restrictive fluid resuscitation in severe hemorrhagic shock caused by hemorrhagic shock.Method：100 patients with severe multiple trauma and hemorrhagic shock were diagnosed and treated in our hospital from December 2017 to December 2018，which were randomly divided into two groups.The control group received routine active fluid-related resuscitation，and the study group restricted fluid resuscitation.Then analyzed the recovery indicators and GCS indicators，coagulation indicators and complications of two groups.Result：After treatment，the fluid input （1 620.54±651.23）ml and preoperative resuscitation （62.23±10.46）min in the study group were lower than those in the control group，and the GCS （9.81±1.06）points was higher than that of the control group（P<0.05）.The PT （13.06±1.23）s，APTT （21.23±1.46）s and TT （12.13±1.26）s in the study group were lower than those in the control group，and the difference was statistically significant（P<0.05）.The operative complications，respiratory failure and inflammatory reaction in the study group were less than those in the control group，and the difference was statistically significant（P<0.05）.Conclusion：The patients with severe multiple trauma and hemorrhagic shock treated with restrictive fluid resuscitation could improve the recovery index and GCS index，reduce the coagulation index，and has fewer complications.

【Key words】 Severe multiple injuries; Hemorrhagic shock; Limited fluid resuscitation; Coagulation index; Recovery index

First-authors address：Houjie Hospital of Dongguan City，Dongguan 523000，China

多發伤主要指同致伤因素下造成机体出血超过一个部位严重创伤，并且多发伤患者机体脏器、组织损伤比较严重，会造成大量失血，进而出现失血性休克，严重影响患者正常生活质量[1-2]。临床通常采用液体复苏治疗方案，以维持机体生命体征稳定，恢复血压及器官灌注，降低失血造成的负面影响[3-4]。为提高患者急救效果，本研究对2017年12月-2018年12月笔者所在医院诊治的50例严重的多发伤并失血性休克患者应用限制液体复苏治疗效果进行分析，具体报告如下。