创伤性休克术前限制性液体复苏对患者的影响
Influence of preoperative limited fluid resuscitation on traumatic shock patients
郑世成 1陈君长 1王坤正 1高宗强 1王伟卓 1王小燕2
作者信息
- 1. 西安交通大学第二附属医院骨科,陕西,西安,710004
- 2. 西安高新医院急救中心,陕西,西安,710075
- 折叠
摘要
目的:探讨术前限制性液体复苏对创伤性休克患者的影响.方法:将96例严重创伤合并未控制出血性休克的患者,依据液体复苏维持收缩压水平随机分为3组,即A组70 mmHg(1 mmHg=0.133 kPa),B组80 mmHg左右和C组在90 mmHg以上.比较各组术前一般及治疗情况、住院期间器官功能衰竭(OD)和死亡率.结果:①各组年龄、损伤评分、开始复苏时间、开始手术时间及碱缺失均无显著性差异.A,B,C 3组之间的术前总输液量有显著性差异,分别为(2487±96),(2696±87),(3200±95)mL(P＜0.05),A,B组间无显著性差异;3组之间输入浓缩红细胞的量有显著性差异,分别为(300±210),(416±163),(800±130)mL(P＜0.05),A,B组间无显著性差异.②C组患者术前血红蛋白含量明显低于A,B组,分别为(90±45),(115±32),(110±34)g/L(P＜0.05),A,B组间无显著性差异.③3组中OD的发生率和病死率C组中高于A,B组(P＜0.05),A,B组无显著性差异.结论:创伤性休克术前在未控制出血情况下,限制性液体复苏可明显降低患者的出血量,并发症和死亡率.
Abstract
AIM: To investigate the influence of preoperative limited fluid resuscitation on traumatic shock patients. METHODS: Ninety-six traumatic shock patients complicated with uncontrolled hemorrhage were randomly divided into 3 groups according to the level of systolic blood pressure(SBP) sustained by different fluid resuscitation: group A (around 70 mmHg),group (around 80 mmHg) and group C(over 90 mmHg). General conditions and fluid resuscitation measurement before operation,and the incidence of organ dysfunction ( OD) and mortality during hospital stay were compared. RESULTS: (1) There was no significant difference in age,gender,injury severity score (ISS),initiated resuscitation time,initiated operation time and base deficit among the three groups. Before operation,there was significant difference in the volume of Quid resuscitation and the volume of infused erythrocyte suspension between the 3 groups. The volume of fluid resuscitation of group A,group B and group C was respectively (2487±96),(2696±87) and(3200±95) mL(P<0.05),with no significant difference between group A and group B (P > 0.05 ). The volume of infused erythrocyte suspension of Group A,group B and group C was respectively(300 ±210),(416 ± 163) and (800 ±130) mL(P<0.05),with no significant difference between group A and group B(P>0.05). (2)The hemoglobin level in group C(90 ±45) g/L was lower than that in group A (115 ±32) g/L,and group B( 110 ±34) g/L,(P<0.05),with no significant difference between group A and group B( P > 0.05). ( 3) The incidence of OD in group C was higher than that in group A and group B(45. 5%,15. 6%,22. 5%,P <0. 05),with no significant difference between group A and group B( P > 0.05). The mortality in group C was higher than that in group A and group B,(39.3%,9.37%,16.1%,P<0.05),with no significant difference between group A and group B ( P > 0. 05 ). CONCLUSION:The results of our study show that the preoperative limited fluid resuscitation can reduce the volume of bleeding,the incidence of OD and mortality rate in traumatic shock patients with uncontrolled hemorrhage.
关键词
创伤性休克/限制性液体复苏/多器官功能衰竭Key words
traumatic shock/limited fluid resuscitation/multiple organ failure引用本文复制引用
出版年
2009
NETL
NSTL
维普
万方数据