液体复苏在未控制性创伤失血性休克中的应用(1)
【摘要】目的 探讨不同液体复苏方式对未控制性创伤失血性休克的治疗效果。方法 回顾性分析2006 年9 月至2010 年10月贵阳医学院附属医院急诊创伤外科收治的未控制性创伤失血性休克患者220例，按常规液体复苏(常规组)和限制性液体复苏(限制组)两种复苏方式分组。常规组使收缩压维持在(90～135)mm Hg，限制组使收缩压维持在(70～90)mm Hg(1 mm Hg=0.133 kPa)。对两组患者的体温、中心静脉压、输血量、尿量、肾功能、血色素、静脉血渗透压(Osm)、MODS和DIC发生率、诊治费用、病死率进行统计学分析，比较限制性液体复苏与常规液体复苏对失血性休克患者的疗效。结果 采用两种不同复苏方式治疗后，两组患者的体温、中心静脉压、输血量、尿量、肾功能、血色素、Osm、MODS和DIC发生率、诊治费用、病死率比较，限制组优于常规组，差异具有统计学意义(P<0.05)；而两组肾功能障碍发生率比较，差异无统计学意义(P>0.05)。结论 在出血未控制的情况下，限制性液体复苏可维持重要脏器的血流灌注、降低出血量、降低MODS发生率和病死率。
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【关键词】失血性休克；创伤；液体复苏
Application of fluid resuscitation in uncontrolled traumatic hemorrhagic shock PENG Wu-xun, WU Jian-hua, GONG Xiang.Department of Emergency and Trauma Surgery, the Affiliated Hospital of Guiyang Medical College ,Guiyang 550004, China
Corresponding author: WU Jian-hua, Email: 125691105@qq.com
【Abstract】Objective To investigate the effects of different ways of fluid resuscitation on uncontrolled traumatic hemorrhagic shock.Methods The retrospective analysis of data from 220 casualties with uncontrolled hemorrhagic shock admitted from September 2006 to October 2010 was carried out. There were two ways of fluid resuscitation used to treat casualties with hemorrhagic shock, conventional fluid resuscitation (group A) and limited fluid resuscitation (group B). The systolic pressure was maintained at 90～135 mm Hg in the group A and at 70～90 mm Hg in the group B. The data of body temperature, central venous pressure, quantity of blood transfused, urine output, renal function, hemoglobin, blood osmotic pressure (Osm) , MODS and DIC rates, treatment costs and mortality of two groups were statistically analyzed and compared. Results After analyses of above mentioned variables except renal function and comparison made between two groups, the method of limited fluid resuscitation was much superior over conventional fluid resuscitation (P<0.05). There was no noticeable difference in rate of compromised renal function between two groups (P>0.05).Conclusions In the case of uncontrolled exsanguination, the method of limited fluid resuscitation can maintain blood perfusion of vital organs, reduce the blood loss and decrease the incidence of MODS and mortality.
【Key words】Hemorrhagic traumatic shock; Trauma; Fluid resuscitation
未控制性创伤失血性休克是由创伤和失血引起休克，而出血部位尚未通过外科手术或介入手段等物理方法达到切实有效的止血者。对于未控制性创伤失血性休克患者而言，早期应充分液体复苏还是限制性液体复苏存在不同认识[1-2]。因此，该研究将贵阳医学院附属医院急诊创伤外科2006年9月至2010年10月收治的220例未控制性创伤失血性休克患者，依据复苏方式不同分组，即常规液体复苏(常规组)和限制性液体复苏(限制组)，对其临床资料和转归进行比较分析，探讨不同液体复苏方式对未控制性创伤失血性休克的治疗效果。, 百拇医药(彭吾训 吴建华 龚翔)
, http://www.100md.com
【关键词】失血性休克；创伤；液体复苏
Application of fluid resuscitation in uncontrolled traumatic hemorrhagic shock PENG Wu-xun, WU Jian-hua, GONG Xiang.Department of Emergency and Trauma Surgery, the Affiliated Hospital of Guiyang Medical College ,Guiyang 550004, China
Corresponding author: WU Jian-hua, Email: 125691105@qq.com
【Abstract】Objective To investigate the effects of different ways of fluid resuscitation on uncontrolled traumatic hemorrhagic shock.Methods The retrospective analysis of data from 220 casualties with uncontrolled hemorrhagic shock admitted from September 2006 to October 2010 was carried out. There were two ways of fluid resuscitation used to treat casualties with hemorrhagic shock, conventional fluid resuscitation (group A) and limited fluid resuscitation (group B). The systolic pressure was maintained at 90～135 mm Hg in the group A and at 70～90 mm Hg in the group B. The data of body temperature, central venous pressure, quantity of blood transfused, urine output, renal function, hemoglobin, blood osmotic pressure (Osm) , MODS and DIC rates, treatment costs and mortality of two groups were statistically analyzed and compared. Results After analyses of above mentioned variables except renal function and comparison made between two groups, the method of limited fluid resuscitation was much superior over conventional fluid resuscitation (P<0.05). There was no noticeable difference in rate of compromised renal function between two groups (P>0.05).Conclusions In the case of uncontrolled exsanguination, the method of limited fluid resuscitation can maintain blood perfusion of vital organs, reduce the blood loss and decrease the incidence of MODS and mortality.
【Key words】Hemorrhagic traumatic shock; Trauma; Fluid resuscitation
未控制性创伤失血性休克是由创伤和失血引起休克，而出血部位尚未通过外科手术或介入手段等物理方法达到切实有效的止血者。对于未控制性创伤失血性休克患者而言，早期应充分液体复苏还是限制性液体复苏存在不同认识[1-2]。因此，该研究将贵阳医学院附属医院急诊创伤外科2006年9月至2010年10月收治的220例未控制性创伤失血性休克患者，依据复苏方式不同分组，即常规液体复苏(常规组)和限制性液体复苏(限制组)，对其临床资料和转归进行比较分析，探讨不同液体复苏方式对未控制性创伤失血性休克的治疗效果。, 百拇医药(彭吾训 吴建华 龚翔)