论文部分内容阅读
临床资料 我院自1992年以来,共收治创伤失血性休克患者73例,其中重症多发伤失血性休克18例.男14例,女4例.年龄为29.8±12岁.其中交通事故伤16例,坠落伤2例.就诊时收缩压均低于8kPa.抢救成功14例,成功率为78%.在治疗中曾发现肺水肿者8例,占44%.因肺水肿合并呼吸衰竭死亡3例;因休克时间过长补入胶体液过量,死于呼吸窘迫综合征1例,死亡率为22%.提示肺部并发症在重症多发伤失血休克病例中常见,是死亡的主要原因.重症多发伤失血休克,损伤部位多、失血量大.基层医院血源不足、供血不及时,为维持生命体征,被迫过量补入晶体液、葡萄糖液的情况并不少见.本组病例中2例患者于术后24小时内死于肺水肿、呼吸衰竭;4例在术中发现病人抽搐,诊断脑水肿、肺水肿.表明逾量补液多发生在入院抢救及术中数小时之内.因此,在损伤脏器的出血得到处理和休克基本纠正后,应在术前或在手术室就应给予脱水利尿.本组曾有一例患者在48小时内曾三次给予脱水利尿,血压稳定,后盲目补给血浆、白蛋白,最终导致心肺功能衰竭死亡.脱水、利尿治疗后多数病例心率、呼吸频率并不迅速下降.表示4例患者在给脱水、利尿后应用低分子右旋糖酐后则心率下降,具有十分显著的统计学意义(t=6.15 P=0.01);呼吸频率随之也明显降低,呼吸困难情况明显改善.
Clinical data in our hospital since 1992, a total of 73 cases of traumatic hemorrhagic shock were treated, including 18 cases of severe multiple traumatic hemorrhagic shock, 14 males and 4 females, aged 29.8 ± 12 years, including traffic accidents in 16 cases , Fall injury in 2 cases.Oral pressure systolic blood pressure were less than 8kPa.Rescue successful in 14 cases, the success rate was 78% .In the treatment of pulmonary edema were found in 8 cases, accounting for 44% .Due to pulmonary edema and respiratory failure in 3 cases ; Due to shock time is too long to fill colloidal fluid excess, died of respiratory distress syndrome in 1 case, the mortality rate was 22% .This suggested that pulmonary complications in severe multiple traumatic hemorrhagic shock cases are common, is the main cause of death. Injury to hemorrhagic shock, injury sites, blood loss. Primary hospital lack of blood supply, blood supply is not timely, in order to maintain vital signs, were forced to excess into the crystalloid, glucose solution is not uncommon in this group of patients 2 patients Died of pulmonary edema and respiratory failure within 24 hours after operation; 4 patients found convulsions in the operation, diagnosed cerebral edema and pulmonary edema, which indicated that excessive fluid replacement occurred within a few hours after admission and resuscitation Damage to organs after bleeding has been dealt with and basic correction of shock should be Dehydration or diuretic should be given before or in the operating room. One patient in our group had dehydrated and diuresed three times within 48 hours, blood pressure was stable, then plasma and albumin were blindly supplied, which eventually led to the death of cardiopulmonary failure. After dehydration and diuretic treatment In most cases, the heart rate and respiratory rate did not decrease rapidly, which showed that the heart rate decreased after dextran and dextrin application in 4 patients (t = 6.15 P = 0.01) Also significantly reduced, dyspnea was significantly improved.