地震创伤失血性休克的容量复苏
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摘要
目的探讨院前创伤失血性休克的容量复苏治疗方法。方法回顾性分析2008年‘5.12’地震期间我院680例未控制出血的休克患者的容量复苏方法,比较常规液体复苏组(320例)和限制性液体复苏组(360例)以及7.5%高渗氯化钠组(180例)的治愈率、多脏器功能衰竭(MODS)、急性呼吸窘迫综合征(ARDS)的发生率及病死率。结果常规液体复苏组治愈率为62.5%(200/320),病死率37.5%(120/320),ARDS发生率为20.9%(67/320),MODS发生率30.9%(99/320);限制性液体复苏组治愈率为82.8%(298/360),病死率17.2%(62/360),ARDS发生率为8.9%(32/360),MODS发生率为17.5%(63/360),2组比较差异有统计学意义(P<0.05)。限制性液体复苏组中7.5%高渗氯化钠组治愈率为86.6%(156/180),病死率13.4%(24/180),ARDS发生率为3.3%(6/180),MODS发生率为9.4%(17/180)。结论限制性液体复苏治疗,特别是7.5%高渗氯化钠更能减少未控制出血性休克患者MODS和ARDS的发生率,提高其治愈率。
objective To explore the effect of limited volume resuscitation of uncontrolled hemorrhagic traumatic shock.Methods 680 cases were retrospectively analyzed.The healing rate incid ence of MOD S and ARDS And mortality rate between regular fluid resuscitation group and limited fluid resuscitation group,and ebtween 7.5% hypertonic saline fluid resuscitation group and lacatate Ringer's fluid resuscitation group were compared.Results Survival rate of regular volume resuscitation group was 62.5%,mortality rate was 37.5%,in idence of ARDS was 20.9%,incidence of MODS was 30.9%.There was statistical significance between two groups(P<0.05).Survival rate of 7.5%hypertonic saline fluid resuscitation group was 86.6%,mortality rate was 13.4%,incidence of MODS was 9.4%,incidence of ARDS was 3.3%.Conclusion Limited volume resuscitation especially 7.5% hypertonic saline volume resuscitation is more rational to improve the prognosis of patients with uncontrolled traumatic shock than regular volume resuscitation.
objective To explore the effect of limited volume resuscitation of uncontrolled hemorrhagic traumatic shock.Methods 680 cases were retrospectively analyzed.The healing rate incid ence of MOD S and ARDS And mortality rate between regular fluid resuscitation group and limited fluid resuscitation group,and ebtween 7.5% hypertonic saline fluid resuscitation group and lacatate Ringer's fluid resuscitation group were compared.Results Survival rate of regular volume resuscitation group was 62.5%,mortality rate was 37.5%,in idence of ARDS was 20.9%,incidence of MODS was 30.9%.There was statistical significance between two groups(P<0.05).Survival rate of 7.5%hypertonic saline fluid resuscitation group was 86.6%,mortality rate was 13.4%,incidence of MODS was 9.4%,incidence of ARDS was 3.3%.Conclusion Limited volume resuscitation especially 7.5% hypertonic saline volume resuscitation is more rational to improve the prognosis of patients with uncontrolled traumatic shock than regular volume resuscitation.
引文
1王钦存.限制性液体复苏对出血未控制休克后续救治的影响[J].中国实用外科杂志,2004,24(6):354.
2陈晓雄,叶恭水,帅学军,等.重症胸部创伤合并创伤失血性体克限制性液体复苏的疗效评价[J].中国急救医学,2004,3:178-180.
3沈洪.创伤早期液体复苏的利与弊[J].中华急诊医学杂志,2002,11(2):136.
2陈晓雄,叶恭水,帅学军,等.重症胸部创伤合并创伤失血性体克限制性液体复苏的疗效评价[J].中国急救医学,2004,3:178-180.
3沈洪.创伤早期液体复苏的利与弊[J].中华急诊医学杂志,2002,11(2):136.
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