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目的探讨延迟与即刻液体复苏对胸腹联合伤并创伤性休克患者的早期救治效果。方法回顾性分析2004年11月至2006年12月来院救治的98例胸腹联合伤并创伤性休克患者资料,所有病例均符合第五版《外科学》休克诊断标准。延迟复苏组(n=51),在到达手术室彻底止血前,只给予少量的平衡液维持机体基本需求;即刻复苏组(n=47),入院后快速给予大量等张晶体液和(或)胶体液。用成组t检验、方差分析或x~2检验分析两种液体复苏方式对血红蛋白含量、血小板计数、红细胞比容、血乳酸含量、碱缺失水平、术前复苏时间及病死率的影响。结果延迟复苏组与即刻复苏组输液量差异具有统计学意义[(1586±346)vs(3520±575)ml,P<0.01],但两组患者在手术前收缩压却差异无统计学意义[(78±29)mmHg vs(8l±24)mmHg,P>0.05]。术前血红蛋白[(106.21±20.91)g/L vs(89.10±32.42)g/L]、凝血酶原时间[(11.19±2.03)s vs(17.37±2.50)s]、血小板计数[(179.44±52.19)×10~9/L vs(105.55±50.67)×10~9/L]、红细胞比容[(28.40±2.31)% vs(20.84±2.58)%]、血乳酸[复苏30 min:(1.70±0.37)mmol/L vs(2.44±0.41)mmol/L;复苏60min:(3.16±0.42)mmol/L vs(5.73±0.68)mmol/L]和碱缺失[复苏30min:(-4.46±1.15)mmol/L vs(-5.78±1.15)mmol/L;复苏60min:(-5.46±1.29)mmol/L vs(-9.60±2.71)mmol/L],两组间差异具有统计学意义(P<0.05)。即刻复苏组术前复苏时间(73±29) min、病死率(18.9%),延迟复苏组术前复苏时间(58±26)min、病死率(11.3%),组间比较差异有统计学意义(P<0.05)。结论延迟液体复苏能显著改善胸腹联合伤并创伤失血性休克患者凝血功能、组织和器官的灌注及乳酸酸中毒程度,降低患者的病死率,缩短术前复苏时间,效果优于即刻液体复苏。
Objective To investigate the early treatment effect of delayed and immediate liquid resuscitation on patients with thoracoabdominal and traumatic shock. Methods A retrospective analysis of 98 patients with thoracoabdominal trauma and traumatic shock treated in our hospital from November 2004 to December 2006 was conducted. All cases were in accordance with the diagnostic criteria of the fifth edition of “Surgery” shock. Delayed resuscitation group (n = 51) received only a small amount of equilibration solution to maintain the basic needs of the body before reaching the operating room for complete hemostasis. Immediate resuscitation group (n = 47) received a large amount of isotonic crystalloid and / Colloidal fluid. The effects of two liquid resuscitation methods on hemoglobin, platelet count, hematocrit, blood lactic acid, alkali loss, preoperative resuscitation time and mortality were analyzed by using group t test, ANOVA or x 2 test. Results The difference of transfusion volume between delayed resuscitation group and immediate resuscitation group was statistically significant [(1586 ± 346) vs (3520 ± 575) ml, P <0.01], but there was no significant difference in preoperative systolic pressure between the two groups [ (78 ± 29) mmHg vs (81 ± 24) mmHg, P> 0.05]. Preoperative hemoglobin [(106.21 ± 20.91) g / L vs (89.10 ± 32.42) g / L], prothrombin time [(11.19 ± 2.03) s vs (17.37 ± 2.50) s], platelet count [(179.44 ± 52.19 ) (P> 0.05). The hematocrit [(28.40 ± 2.31)% vs (20.84 ± 2.58)%], blood lactate [recovery 30 min: (1.70 ± (3.16 ± 0.42) mmol / L vs (5.73 ± 0.68) mmol / L] and alkaline deficit [resuscitation 30min: (-4.46 ± 1.15) mmol / L vs / L vs (-5.78 ± 1.15) mmol / L respectively; the recovery time was 60min: (-5.46 ± 1.29) mmol / L vs (-9.60 ± 2.71) mmol / L] . The rate of preoperative resuscitation (73 ± 29) min, case fatality rate (58.96%), preoperative resuscitation time (58 ± 26) min and case fatality rate (11.3%) in immediate resuscitation group were significantly different (P <0.05). Conclusion Delayed liquid resuscitation can significantly improve the coagulation function, tissue and organ perfusion and lactic acidosis in patients with thoracoabdominal combined trauma and traumatic hemorrhagic shock, reduce the mortality and shorten the time of preoperative resuscitation, which is better than immediate liquid resuscitation.