摘要:
Objective To investigate the clinical value of immediate fluid resuscitation and delayed resuscitation in patients with traumatic shock. Methods The patients with traumatic shock treated in the Critical Care Medicine Department of People's Hospital of Wenjiang District from March 2014 to March 2017 were selected. According to the number of admission cases,one hundred and twenty patients with traumatic shock were randomly divided into two groups,60 cases in each group. The control group was given early immediate fluid resuscitation,the observation group was given delayed resuscitation,and the blood coagulation and blood routine indexes of the two groups were compared before and after the fluid resuscitation in the two groups,and the amount of fluid rehydration and the fatality rate in the two groups of patients with 1 h shock were observed,and the incidence rate of acute respiratory distress syndrome ( ARDS) and multiple organ dysfunction syndrome (MODS) were compared. Results After treatment,the blood clotting and blood routine indexes of the two groups were improved (P<0. 05),of which the thromboplastin time (PT) ((11. 04±1. 17) s),activated partial thromboplastin time (APTT) ((28. 12±5. 93) s) in the observation group in the observation group were lower than those of the control group( (15. 12±1. 26) s,(36. 17±9. 05) s) (t = -15. 37,-9. 81,P<0. 05),platelet countPLT) ((146. 92±16. 85)×109 / L) was higher than that of the control group ((114. 18±10. 69)×109 / L ) (t= -9. 77,P<0. 05),and the blood routine hemoglobin (Hb) ((112. 21±9. 46) g/ L),and the base surplus (BE)((-5. 30 ± 2. 45) mmol/ L ) were all higher than those of the control group ((92. 95 ± 11. 20) g/ L, (-8. 27±3. 53) mmol/ L ) (t= -11. 46,-8. 99,P<0. 05),blood lactic acid (BL) ((2. 79±1. 12) mmol/ L ) was lower than that of the control group ((3. 54±1. 37) mmol/ L) (t = -8. 99,P<0. 05). The volume of 1 h infusion of shock in the observation group ((569. 96±187. 34) ml ) was lower than that of the control group((1957. 35±204. 14) ml) (t = 8. 725,P<0. 05). The incidence of ARDS (3. 33% (2/ 60)),MOD(3. 33%(2/ 60)) and fatality(1. 67%(1/ 60)) were lower than those of the control group(8. 33%(5/ 60),6. 67%(4/60),6. 67%(4/ 60) ( χ2 = 2. 725,3. 214,2. 985,P< 0. 05) . Conclusion The early stage of traumatic shock delayed fluid resuscitation is conducive to the protection of the blood coagulation function of patients,to improve blood indicators,to reduce the amount of 1 h infusion and to reduce the incidence of ARDS and MODS.%目的 比较早期即刻补液与延迟补液复苏创伤性休克患者临床效果.方法 选择2014年3月至2017年3月我院重症医学科收治的创伤性休克患者,以入院病例号为编号,根据随机数字表,将120例创伤性休克患者随机分成两组,每组60例.对照组给予早期即刻补液复苏;观察组给予延迟补液复苏;对比两组患者复苏前后血凝学、血常规指标,观察两组患者休克1 h内的补液量和病死率,以及两组患者急性呼吸窘迫综合征(acute respiratory distress syndrom,ARDS)、 多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)的发病率.结果 治疗后两组凝血和血常规各项指标均较其治疗前改善(P<0.05),其中观察组凝血酶原时间(prothrombin time,PT)(11.04±1.17)s、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)(28.12±5.93)s均较对照组[(15.12±1.26)、(36.17±9.05)s]降低(t值分别为-15.37、-9.81,P均<0.05),血小板计数(platelet count,PLT)(146.92±16.85)×109/L,较对照组(114.18±10.69)×109/L升高(t=-9.77,P<0.05);血红蛋白(hemoglobin,Hb)(112.21±9.46)g/L、剩余碱(base excess,BE)(-5.30±2.45)mmol/L均高于对照组[(92.95±11.20)g/L、(-8.27±3.53)mmol/L](t值分别为-11.46、-8.99,P均<0.05),血乳酸(blood lactic acid,BL)(2.79±1.12)mmol/L低于对照组(3.54±1.37)mmol/L(t=-8.99,P<0.05).观察组休克第1小时内补液量(569.96±187.34)ml低于对照组(1957.35±204.14)ml(t=8.725,P<0.05),且ARDS发病率[3.33%(2/60)]、MODS发病率[3.33%(2/60)]及病死率[1.67%(1/60)]均低于对照组[8.33%(5/60)、6.67%(4/60)、6.67%(4/60)](χ2值分别为2.725、3.214、2.985,P均<0.05).结论 创伤性休克早期采用延迟补液复苏有利于保护患者的凝血功能,改善血常规指标,减少第1小时内补液量,同时降低ARDS和MODS发生率.