摘要
目的探讨限制性与积极性液体复苏对伴多发伤的中重型颅脑损伤患者凝血功能和预后的影响.方法选取本院2015年4月~2017年3月收治的146例中重型颅脑损伤伴发多发伤患者进行研究分析,将所选患者按照随机数字表法分为积极组与限制组各73例,积极组给予积极性液体复苏,限制组给予限制性液体复苏.回顾性分析两组患者的临床资料,观察两组患者液体复苏情况,并记录对比两组治疗前后凝血功能指标及剩余碱(BE)及乳酸(LA)水平,同时评估两组患者颅内出血进展情况,并采用格拉斯哥预后评分(GOS)评估预后恢复情况.结果积极组患者的平均液体输入量明显高于限制组患者(P<0.05);积极组患者的胶体使用量及早期复苏时间均高于限制组患者,但两组对比不存在明显差异(P>0.05).治疗后,限制组患者的血清APTT、TT、PT、D-D水平及BE及LA水平均明显低于积极组患者(P<0.05).治疗后,积极组患者颅内出血进展与进展后手术所占比例明显高于限制组患者(P<0.05),且积极组患者入院后1周的GCS评分明显低于限制组患者(P<0.05).限制组患者的预后良好率(38.36%)明显高于积极组患者(64.38%)(P<0.05).积极组患者的并发症发生率(20.55%)及死亡率(12.33%)均明显高于限制组患者(9.59%和5.48%)(P<0.05).结论限制性液体复苏治疗伴多发伤的中重型颅脑损伤患者不仅可以有效降低复苏液使用量,纠正患者凝血功能障碍,同时可以有效改善患者休克期组织脏器的灌注及氧供,减少颅内再出血率,对改善患者预后有重要意义.
Objective To compare the effects of limited and active liquid resuscitation on coagulation function and prognosis in multiple traumas with moderate and severe craniocerebral injury. Methods 146 moderate and severe craniocerebral injury with multiple traumas treated in our hospital from Apr 2015 to Mar 2017 were analyzed and randomly divided into active group(n=73) and limited group(n=73), according to the random number table. The clinical data of the two groups were analyzed retrospectively. The fluid resuscitation, coagulation function indexes, base excess(BE) and lactic acid(LA) concentrations were observed and recorded. The progress of intracranial hemorrhage was also evaluated between the two groups. And the prognosis was assessed by Glasgow Outcome Scale(GOS). Results The average fluid intake in the active group was significantly higher than that in the limited group(P<0.05). The colloid usage and early resuscitation time in the active group were higher than those in the limited group, with no significant difference between the two groups(P>0.05). After treatment, serum APTT, TT, PT, and D-D levels were significantly decreased(P<0.05), which were lower in the limited group than in the active group(P<0.05);After treatment, the BE and LA levels in the limited group were significantly lower than those in the active group(P<0.05). After treatment, the proportion of intracranial hemorrhage progression and postoperative surgery in the active group was significantly higher than that in the limited group(P<0.05). 1 week after admission, the GCS scores of the active group were significantly lower than those in the limited group(P<0.05);The good prognosis rate in the limited group was significantly higher than that in the active group(38.36% vs 64.38%, P<0.05). The incidence of complications(20.55%) and mortality(12.33%) in the active group were significantly higher than those in the restricted group(9.59% and 5.48%)(P<0.05). Conclusion Compared with the active liquid resuscitation, the limited liquid resuscitation can effectively reduce the amount of resuscitation fluid, ameliorate the coagulation dysfunction, improve the organ perfusion and oxygen supply in shock stage, decrease the incidence rate of the intracranial rebleeding, and improve the prognosis of moderate and severe craniocerebral injury with multiple traumas.
作者
向庆勇
黎明
文家智
XIANG Qingyong;LI Ming;WEN Jiazhi(Department of Neurosurgery, Aba Tibetan and Qiang Autonomous Prefecture People's Hospital,Aba 624000,Sichuan,China)
出处
《西部医学》
2019年第6期894-899,共6页
Medical Journal of West China
基金
四川省教育厅自然科学重点项目(12ZA041)
关键词
液体复苏
多发伤
中重型颅脑损伤
凝血功能
预后
Fluid resuscitation
Multiple traumas
Moderate and severe craniocerebral injury
Coagulation function
Prognosis
