限制性液体复苏在急诊多发伤合并休克患者中的应用效果
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摘要
目的观察限制性液体复苏在急诊多发伤合并休克患者中的应用效果。方法将多发伤合并休克患者116例依据随机数字表法分为对照组与观察组,每组58例。对照组行积极性液体复苏,观察组行限制性液体复苏。比较两组血清乳酸、凝血功能、炎性指标及抢救效果。结果复苏3 h后,观察组血清乳酸、血清白细胞介素-6、肿瘤坏死因子-α水平均较对照组低,凝血酶原、活化部分凝血活酶时间均较对照组短,且抢救效果优于对照组,差异具有统计学意义(P<0.05)。结论急诊多发伤合并休克患者应用限制性液体复苏可降低血乳酸水平,改善凝血功能并缓解机体炎症反应,有效提升患者抢救效果,降低不良事件的发生率。
Objective To observe the application effect of limited fluid resuscitation in emergency patients with multiple trauma and shock. Methods 116 emergency patients with multiple trauma and shock were randomly divided into the control group and the observation group, 58 cases in each group. Control group was given positive fluid resuscitation, while the observation group was given limited fluid resuscitation. The serum lactic acid, coagulation function, inflammatory indexes and rescue effect were compared between the two groups. Results After resuscitation for 3 h, the serum lactic acid, serum interleukin-6 and tumor necrosis factor-α in observation group were lower than those in control group;the prothrombin and activated partial thromboplastin time in observation group were shorter than those in control group;the rescue effect of observation group was better than that of control group. The difference was statistically significant(P<0.05). Conclusion Limited fluid resuscitation in emergency patients with multiple trauma and shock can decrease the level of lactic acid, improve coagulation function, relieve inflammatory response, increase rescue effects and reduce the incidence of adverse events.
Objective To observe the application effect of limited fluid resuscitation in emergency patients with multiple trauma and shock. Methods 116 emergency patients with multiple trauma and shock were randomly divided into the control group and the observation group, 58 cases in each group. Control group was given positive fluid resuscitation, while the observation group was given limited fluid resuscitation. The serum lactic acid, coagulation function, inflammatory indexes and rescue effect were compared between the two groups. Results After resuscitation for 3 h, the serum lactic acid, serum interleukin-6 and tumor necrosis factor-α in observation group were lower than those in control group;the prothrombin and activated partial thromboplastin time in observation group were shorter than those in control group;the rescue effect of observation group was better than that of control group. The difference was statistically significant(P<0.05). Conclusion Limited fluid resuscitation in emergency patients with multiple trauma and shock can decrease the level of lactic acid, improve coagulation function, relieve inflammatory response, increase rescue effects and reduce the incidence of adverse events.
引文
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[9]李力卓,何松柏.限制性液体复苏联合损伤控制手术在严重多发伤伴低血容量性休克急诊救治中的意义[J].大连医科大学学报,2016,38(4):344-347.
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[2]张颖,肖小培.限制性液体对创伤失血性休克患者的抢救效果及对血清NO、ET及cTnI的影响[J].贵州医药,2017,41(5):497-499.
[3]茆勇,应佑国,徐伟,等.限制性液体复苏与常规液体复苏对失血性休克患者临床疗效分析[J].现代生物医学进展,2017,17(15):2853-2856.
[4]尹松涛,李玲雁,张国君,等.不同液体复苏对多发伤伴失血性休克患者凝血功能及髓系抑制性细胞数的影响[J].广西医科大学学报,2017,34(11):1611-1613.
[5]中华医学会创伤学分会创伤急救与多发伤学组.多发伤病历与诊断:专家共识意见(2013版)[J].创伤外科杂志,2014,16(2):192,封3.
[6]王滨,王馨翊.限制性液体复苏与常规液体复苏治疗失血性休克的疗效对比研究[J].河北医学,2017,23(6):895-897.
[7]韩加裕,张思泉,周可幸,等.限制性液体复苏治疗34例创伤失血性休克患者的临床分析[J].中华全科医学,2016,14(11):1841-1843.
[8]尤建权,于情,戴佳文,等.限制性液体复苏在创伤失血性休克中的临床应用[J].中华急诊医学杂志,2016,25(10):1301-1303.
[9]李力卓,何松柏.限制性液体复苏联合损伤控制手术在严重多发伤伴低血容量性休克急诊救治中的意义[J].大连医科大学学报,2016,38(4):344-347.
[10]汤华林,王亮,刘振新,等.限制性液体复苏对多发性骨折合并创伤失血性休克患者免疫功能和炎症介质的影响[J].中国中西医结合急救杂志,2017,24(4):393-395.