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目的探讨限制性液体复苏对院前抢救创伤非控制出血性休克的影响。方法选择创伤非控制出血性休克227例,其中A组(限制性液体复苏组)117例,2010年1月至2011年10月期间,采用限制性液体复苏行院前抢救。B组(充分液体复苏组)120例,选取既往患者,当时采用了充分液体复苏行院前抢救,比较2组院前输液量、术前输液量、病死率及术前实验室指标:血红蛋白(Hb)、血小板计数(PLT)、凝血酶原时间(PT)、部分凝血酶原时间(APTT)、血气剩余碱(BE)情况。结果限制性液体复苏组院前输液量少(650±310)mL与(2580±720)mL;术前输液量低(829±227)mL与(2831±269)mL;病死率低21.37%与34.99%;术前实验室指标:限制性液体复苏组PT较短(11.2±1.5)s与(16.8±2.0)s,APTT较短(30±14)s与(40±19)s,PLT数量多(270±94)×109/L与(230±92)×109/L;BE多(-7.0±5.7)mmol/L与(-9.9±5.8)mmol/L,2组差异均有统计学意义(P<0.05)。结论院前急救采用限制性液体复苏能减少输液量,可维持重要器官的血流灌注,减少代谢性酸中毒,为争取进一步治疗赢得时间,改善预后及降低病死率,适宜临床救治。
Objective To investigate the effect of restrictive fluid resuscitation on the non-controlled hemorrhagic shock in hospital. Methods A total of 227 cases of uncontrolled hemorrhagic shock were selected, including 117 cases in group A (restricted fluid resuscitation group) and hospitalized with restricted fluid resuscitation from January 2010 to October 2011. Group B (full liquid resuscitation group) 120 cases, select the previous patients, was used to rescue adequate liquid resuscitation hospital before treatment, compared two groups of infusion, preoperative infusion, mortality and preoperative laboratory indicators: hemoglobin Hb), platelet count (PLT), prothrombin time (PT), partial prothrombin time (APTT), remaining blood gas (BE). Results Pre-hospital infusion was less (650 ± 310) mL and (2580 ± 720) mL in the restricted liquid resuscitation group than in the pre-hospital resuscitation group (829 ± 227) mL and (2831 ± 269) mL respectively 34.99%. The preoperative laboratory indexes were shorter (11.2 ± 1.5) s and (16.8 ± 2.0) s, shorter APTT (30 ± 14) s and (40 ± 19) s, (270 ± 94) × 109 / L and (230 ± 92) × 109 / L, BE more (-7.0 ± 5.7) mmol / L and (-9.9 ± 5.8) mmol / L respectively Significance (P <0.05). Conclusion Pre-hospital rescue using restrictive fluid resuscitation can reduce the infusion volume, maintain the blood perfusion of vital organs and reduce the metabolic acidosis. It is suitable for clinical treatment for further treatment to win the time, improve the prognosis and reduce the mortality.