摘要
目的探讨高渗盐水联合限制性液体复苏对创伤失血性休克患者的临床价值。方法90例患者随机分为三组：限制性液体复苏组（组1）、高渗盐水＋限制性液体复苏组（组2）、正压复苏组（组3），每组30例。5-组患者均输注乳酸林格氏液及羟乙基淀粉．两者比例2：1～3：1。组3目标血压为平均动脉压（MAP）〉80mmHg，组1及组2目标血压为MAP60mmHg左右。比较三组的补液量、PT、APTT、血红蛋白、碱剩余、乳酸、体温、TNF-α、MODS发病率、病死率。结果①三组的一般资料无统计学差异（P〉0．05）．②三组患者的补液量、输注红细胞、PT、APTT、BE、乳酸以及TNF—α水平均有统计学差异（P〈0．05），组3显著高于组1、组2，组1显著高于组2（P〈0．05）。③三组的血红蛋白浓度有统计学差异（P〈0．05），组3显著低于组1、组2（P〈0．05），组1、组2间无显著差异（P〉0．05）。④三组体温有统计学差异（P〈0.05），组3显著低于组1、组2，组1显著低于组2（P〈0．05）。⑤三组患者MODS及死亡率有显著差异（P〈0．05），组3显著高于组2（P〈0．05），组1、组2间无显著差异（P〉0．05）。结论限制性液体复苏联合高渗盐水复苏作用优于单纯限制性液体复苏及正压复苏。
Objective To explore the clinical value of hypertonic saline combined with limited fluid resuscitation for patients with traumatic hemorrhagic shock. Methods Ninety patients were randomly divided into three groups： group A （limited fluid resuscitation, target MAP 60 mm Hg）, group B （hypertonic saline combined with limited fluid resuscitation, target MAP 60 mm Hg）, and group C （normotensive resuscitation, target MAP more than 80 mm Hg）, with 30 cases in each group. The differences in amount of fluid supplement, PT, APTT, hemoglobin, base excess （BE）, lactic acid, body temperature, TNF-α, morbidity of MODS, and mortality among three groups were analyzed. Results （1）No statistical difference was found among three groups in the general information （P 〉0.05）. （2）The comparison had significant differences in amount of fluid supplement, red blood cell transfusion, PT, APTT, BE, lactic acid, and TNF-α levels among three groups （P 〈0.05）, and the levels were in sequence of group C 〉 group A 〉 group B （P 〈0.05）. （3） The comparison had significant difference in hemoglobin concentration among three groups （P 〈0.05）, group C was significantly lower than the other two groups （P 〈0.05）, and no statistical difference was found between group A and group B （P 〉0.05）. （4）The comparison had significant difference in body temperature among three groups （P〈0.05）, and level was in sequence of group C 〈 group A 〈 group B （P〈0.05）. （5）The comparison had significant differences in morbidity of MODS and mortality among three groups （P〈0.05）, group C was significantly higher than the other two groups （P〈0.05）, and no statistical difference was found between group A and group B （P〉0.05）. Conclusions Hypertonic saline combined with limited fluid resuscitation has better effect than single limited fluid resuscitation and normotensive resuscitation.
出处
《临床医学工程》
2016年第5期592-594,共3页
Clinical Medicine & Engineering
基金
四川省教育厅课题(项目编号:12ZB222)
关键词
创伤
失血性休克
限制性液体复苏
高渗盐水
Trauma
Hemorrhagic shock
Limited fluid resuscitation
Hypertonic saline
