不同液体复苏策略对失血性休克患者并发症及预后影响的研究
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摘要
目的比较不同液体复苏策略对失血性休克患者并发症及预后的影响。方法选择2015年1月—2016年6月在急诊科救治的120例失血性休克患者作为研究对象,随机分为试验组及对照组,其中试验组进行限制性液体复苏,对照组常规液体复苏。比较2组患者液体复苏后血清乳酸(Lac)、红细胞比容(Hct)、国际标准化值(INR)、肿瘤坏死因子-α(TNF-α)及白介素-6(IL-6)的变化情况,同时比较2组并发症发生率及病死率。结果液体复苏后,对照组输液量、MAP及INR明显高于试验组,差异有统计学意义(均P<0.05);试验组动脉Lac较入院时显著下降,且下降幅度大于对照组,差异均有统计学意义(均P<0.05)。同时,2组患者红细胞比容液体复苏后均较入院时下降,但对照组下降幅度更大,差异均具有统计学意义(均P<0.05)。液体复苏后,2组患者血清TNF-α和IL-6浓度均较入院时明显上升,但对照组上升幅度更大,差异均有统计学意义(均P<0.05)。而试验组MODS、ARDS的发生率及死亡率分别为18.3%,25.0%及6.7%,显著低于对照组(分别40.0%,41.7%及25.0%),差异均有统计学意义(均P<0.05)。结论限制性液体复苏可有效改善失血性休克的凝血功能,抑制炎症反应,从而降低并发症的发生率,改善患者预后。
Objective To explore the effect of different liquid resuscitation strategy on the complications and prognosis of patients with hemorrhagic shock.Methods We selected 120 cases of with hemorrhagic shock in our hospital from January,2015 and June,2016 as the research object,divided them into observation group( 60 patients) and control group( 60 patients) by random number table method.The patients in the observation group were given a limited fluid resuscitation,and the patients in the control group received traditional full recovery.The changes of Lac,Hct,INR,plasma TNF-αand IL-6 levels in two groups were observed before and after the treatment,and the incidence of complications and mortality between the two groups were compared.Results After the treatment,the input of recovery fluid,the MAP and INR in the control group were significant higher than those in the observation group,the difference was statistically significant( P < 0.05).The level of Lac in the observation group was declined much more significantly than the control group,which had statistical significance( P < 0.05).Hct were significantly decreased in both groups after the treatment,and the control group decreased much more,the differences were statistically significant( P < 0.05).The plasma levels of TNF-αand IL-6 in the two groups were significantly increased,and the levels of plasma TNF-α and IL-6 in the observation group were significantly lower than those in the control group after the treatment,the difference was statistically significant( P <0.05).The incidences of MODS,ARDS and the mortality in the observation group were 18.3%,25.0% and 6.7%,respectively,significantly lower than those in the control group( 40.0%,40.0% and 41.7%,respectively),the difference was statistical significant( P < 0.05).Conclusion Limited fluid resuscitation can effectively improve the coagulation function of hemorrhagic shock,inhibit the inflammatory reaction,thereby reducing the incidence of complications,and improve the prognosis of patients.
Objective To explore the effect of different liquid resuscitation strategy on the complications and prognosis of patients with hemorrhagic shock.Methods We selected 120 cases of with hemorrhagic shock in our hospital from January,2015 and June,2016 as the research object,divided them into observation group( 60 patients) and control group( 60 patients) by random number table method.The patients in the observation group were given a limited fluid resuscitation,and the patients in the control group received traditional full recovery.The changes of Lac,Hct,INR,plasma TNF-αand IL-6 levels in two groups were observed before and after the treatment,and the incidence of complications and mortality between the two groups were compared.Results After the treatment,the input of recovery fluid,the MAP and INR in the control group were significant higher than those in the observation group,the difference was statistically significant( P < 0.05).The level of Lac in the observation group was declined much more significantly than the control group,which had statistical significance( P < 0.05).Hct were significantly decreased in both groups after the treatment,and the control group decreased much more,the differences were statistically significant( P < 0.05).The plasma levels of TNF-αand IL-6 in the two groups were significantly increased,and the levels of plasma TNF-α and IL-6 in the observation group were significantly lower than those in the control group after the treatment,the difference was statistically significant( P <0.05).The incidences of MODS,ARDS and the mortality in the observation group were 18.3%,25.0% and 6.7%,respectively,significantly lower than those in the control group( 40.0%,40.0% and 41.7%,respectively),the difference was statistical significant( P < 0.05).Conclusion Limited fluid resuscitation can effectively improve the coagulation function of hemorrhagic shock,inhibit the inflammatory reaction,thereby reducing the incidence of complications,and improve the prognosis of patients.
引文
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[13]Besen BA,Gobatto AL,Melro LM,et al.Fluid and electrolyte overload in critically ill patients:An overview[J].World J Crit Care Med,2015,4(2):116-129.
[14]李瑞,刘江伟,钱建辉,等.沙漠干热环境下创伤失血性休克大鼠血清TNF-α、IL-6变化与继发性肺损伤及细胞凋亡的关系研究[J].解放军医学杂志,2014,39(8):645-649.
[15]曾凡源,邓曾斌,胡民坚,等.限制性液体复苏抢救非控制性失血性休克临床观察[J].中华实用诊断与治疗杂志,2014,28(1):51-52.
[2]马锦华,刘喜文.创伤失血性休克液体复苏的研究进展[J].中国急救复苏与灾害医学杂志,2015,10(5):476-479.
[3]陈光丑.失血性休克患者的液体复苏策略探讨[J].浙江临床医学,2015,17(2):197-198.
[4]赵晓东.战(创)伤失血性休克的液体复苏策略及存在的问题[J].中华急诊医学杂志,2013,22(20):1080-1083.
[5]乔着意,韩鹃,王兴志,等.3%和7.5%高渗盐水治疗创伤失血性休克的临床研究[J].中华急诊医学杂志,2014,23(5):496-500.
[6]Bullens LM,van Runnard Heimel PJ,van der Hout-van der Jagt MB,et al.Interventions for Intrauterine Resuscitation in Suspected Fetal Distress During Term Labor:A Systematic Review[J].Obstet Gynecol Surv,2015,70(8):524-539.
[7]沈岩.创伤性凝血病的诊治[J].创伤外科杂志,2015,17(5):478-481.
[8]李辉,陈少军,唐朝晖,等.多发伤患者低体温、酸中毒及凝血功能障碍临床研究[J].中华急诊医学杂志,2015,24(3):310-314.
[9]Maegele M,Sch9chl H,Cohen MJ.An update on the coagulopathy of trauma[J].Shock,2014,41(Suppl 1):21-25.
[10]扈丽媛,焦海涛.限制性液体复苏在治疗严重多发伤导致失血性休克的疗效观察[J].中国急救医学,2014,34(7):14-15.
[11]Stawicki SP,Kent A,Patil P,et al.Dynamic behavior of venous collapsibility and central venous pressure during standardized crystalloid bolus:A prospective,observational,pilot study[J].Int J Crit Illn Inj Sci,2015,5(2):80-84.
[12]Liu GQ,Zuo XH,Jiang LN,et al.Inhibitory effect of post-hemorrhagic shock mesenteric lymph drainage on the HMGB1 and RAGE in mouse kidney[J].Ren Fail,2016,38(1):131-136.
[13]Besen BA,Gobatto AL,Melro LM,et al.Fluid and electrolyte overload in critically ill patients:An overview[J].World J Crit Care Med,2015,4(2):116-129.
[14]李瑞,刘江伟,钱建辉,等.沙漠干热环境下创伤失血性休克大鼠血清TNF-α、IL-6变化与继发性肺损伤及细胞凋亡的关系研究[J].解放军医学杂志,2014,39(8):645-649.
[15]曾凡源,邓曾斌,胡民坚,等.限制性液体复苏抢救非控制性失血性休克临床观察[J].中华实用诊断与治疗杂志,2014,28(1):51-52.