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

摘要

目的 观察限制性液体复苏(LFR)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.方法 选择2014年1月至2016年6月宁波大学医学院附属医院收治的102例多发性骨折合并创伤失血性休克患者,按随机数字表法分为LFR组及早期充分常规液体复苏(RFR)组,每组51例.两组入院后均对患者创面进行包扎止血,并做好术前准备.RFR组患者实施早期充分RFR,LFR组患者实施LFR.观察两组患者复苏后4 h血细胞比容(HCT)、血小板计数(PLT)、凝血酶原时间(PT)、血乳酸、免疫细胞、炎症介质及微小RNA-155(miR-155)等的变化.结果 与RFR组比较,LFR组复苏时间(h:3.67±1.45比5.14±1.61)、PT(s:11.43±2.21比15.73±2.52)、血乳酸(mmol/L:3.35±0.15比3.81±0.25)、肿瘤坏死因子-α〔TNF-α(ng/L):14.10±3.39比16.28±3.47〕、白细胞介素〔IL-10(ng/L):31.43±10.51比40.09±13.23,IL-6(ng/L):490.10±55.13比610.30±63.15〕、内皮素-1〔ET-1(pg/L):183.35±30.51比250.01±31.23〕含量均明显降低(均P<0.01),PLT(×109/L:134.58±28.13比108.12±30.35)、HCT(×10-2:0.34±0.04比0.24±0.05)、miR-155(0.15±0.02比0.08±0.02)、CD4+CD25+调节性T细胞〔CD4+CD25+Treg(×10-2):2.28±0.47比2.10±0.39〕均明显升高(均P<0.01).结论 LFR在抢救多发性骨折合并创伤失血性休克患者时能有效缩短复苏时间,调节患者凝血功能,减少不必要的液体过多输注,改善机体免疫状态和炎症反应程度.%Objective To observe the effects of limited fluid resuscitation (LFR) on immune function and inflammatory mediators in patients with multiple bone fracturescomplicated with traumatic hemorrhagic shock. Methods One hundred and two patients with multiple bone fractures complicated with traumatic hemorrhagic shock admitted to the Affiliated Hospital of Medical College of Ningbo University from January 2014 to June 2016 were enrolled, and they were divided into a LFR group and a early sufficient routine fluid resuscitation (RFR) group by random number table, each group 51 cases. After admission, the patients in the two groups underwent bandaging and hemostasis at the traumatic sites and preoperative management was prepared. The patients in RFR group were treated with early sufficient RFR, while LFR group was treated with LFR. The changes of hematocrit (HCT), blood platelet count (PLT), prothrombin time (PT), blood lactic acid and immune cells, inflammatory mediators and micro RNA-155 (miR-155) were observed in patients of the two groups at 4 hours after resuscitation.Results Compared with RFR group, the resuscitation time (hours: 3.67±1.45 vs. 5.14±1.61), levels of PT (s: 11.43±2.21 vs. 15.73±2.52), serum lactic acid (mmol/L: 3.35±0.15 vs. 3.81±0.25), tumour necrosis factor-α [TNF-α (ng/L): 14.10±3.39 vs. 16.28±3.47], interleukin [IL-10 (ng/L): 31.43±10.51 vs. 40.09±13.23, IL-6 (ng/L): 490.10±55.13 vs. 610.30±63.15] and endothelin-1 [ET-1 (pg/L): 183.35±30.51 vs. 250.01±31.23] in LFR group were significantly decreased (allP < 0.01), while PLT (×109/L: 134.58±28.13 vs. 108.12±30.35), HCT (×10-2: 0.34±0.04 vs. 0.24±0.05), miR-155 (0.15±0.02 vs. 0.08±0.02) and CD4+CD25+ regulatory T cell [CD4+CD25+Treg (×10-2): 2.28±0.47 vs. 2.10±0.39] in LFR group were obviously increased (allP < 0.01).Conclusions Using LFR in the emergency treatment of patients with multiple bone fractures complicated with traumatic hemorrhagic shock can effectively shorten the resuscitation time, regulate the patients' coagulation function, reduce the unnecessary excessive liquid infusion, improve immune status and decrease the degree of inflammatory reaction.