摘要
目的比较两种液体复苏方式对失血性休克患者血常规、凝血功能、肾功能指标及预后的影响。方法选取2018年6月—2019年2月我院急诊科收治的83例失血性休克患者,根据液体复苏方式的不同分为研究组40例和对照组43例,病因治疗前分别给予限制性液体复苏、常规液体复苏。比较两组液体复苏前、液体复苏12 h后血小板(PLT)、血红蛋白(Hb)、红细胞压积(Hct)、凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT),以及血尿素(BUN)、血肌酐(SCr)水平;比较两组复苏液使用量,以及两组存活患者液体复苏后24 h并发症发生情况。结果液体复苏12 h后,两组PLT、Hb及Hct均较治疗前显著升高,且研究组PLT、Hb及Hct升高程度更为显著,差异均有统计学意义(P<0.05或P<0.01)。液体复苏12 h后,两组PT、TT及APTT水平明显升高,且研究组PT、TT及APTT水平明显低于对照组,差异均有统计学意义(P<0.05)。液体复苏12 h后,两组BUN、SCr水平均较治疗前显著降低,且研究组BUN、SCr改善程度更为显著,差异均有统计学意义(P<0.05或P<0.01)。研究组复苏液使用量少于对照组(t=2.387,P=0.024)。研究组存活患者液体复苏后24 h并发症发生率为12.82%明显低于对照组的33.33%(χ2=4.494,P=0.034)。结论限制性液体复苏可减少失血性休克患者复苏液使用量,改善有效循环血量,保护肾脏功能,维持凝血功能稳定,降低并发症发生率。
Objective To compare the effects of two fluid resuscitation methods on blood routine,coagulation function,renal function indicators and prognosis in patients with hemorrhagic shock.Methods From June 2018 to February 2019,83 patients with hemorrhagic shock were divided into research group(n=40)and control group(n=43)according to different means of fluid resuscitation.Restricted fluid resuscitation and conventional fluid resuscitation were given before etiological treatment.The levels of platelet(PLT),hemoglobin(Hb),hematocrit(Hct),prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT),urea(BUN)and serum creatinine(SCr)before and at 12 h after fluid resuscitation were compared between the two groups.The amount of resuscitation fluid was used in the two groups,and complications at 24 h after fluid resuscitation in two groups of survivors were compared.Results At 12 h after fluid resuscitation,PLT,Hb and Hct in the two groups were significantly higher than those before treatment,and the above indicators in the research group were significantly higher(P<0.05 or P<0.01).At 12 h after fluid resuscitation,the levels of PT,TT and APTT in the two groups were increased significantly(P<0.05),and the above levels in the research group were significantly lower than those in the control group(P<0.05).After 12 h after fluid resuscitation,the levels of BUN and SCr in the two groups were significantly lower than those before treatment,and the improvement of BUN and SCr in the research group was more significant(P<0.05 or P<0.01).The amount of resuscitation fluid used in the research group was less than that in the control group(t=2.387,P=0.024).The incidence of complications at 24 h after fluid resuscitation in the research group was 12.82%,which was significantly lower than that in the control group(33.33%,χ2=4.494,P=0.034).Conclusion Restrictive fluid resuscitation can reduce the amount of resuscitation fluid used in patients with hemorrhagic shock,improve the effective circulating blood volume,protect renal function,maintain stable coagulation function,and reduce the incidence of complications.
作者
孟德维
杨雅楠
荣广成
马伟松
高兵兵
王伟
褚雄兵
MENG De-wei;YANG Ya-nan;RONG Guang-cheng;MA Wei-song;GAO Bing-bing;WANG wei;CHU Xiong-bing(Department of Emergency,,the Fourth People's Hospital of Langfang,Langfang,Hebei 065700,China;Department of Respiratory,the Fourth People's Hospital of Langfang,Langfang,Hebei 065700,China)
出处
《临床误诊误治》
2020年第1期61-66,共6页
Clinical Misdiagnosis & Mistherapy
基金
河北省医学科学研究重点课题计划项目(20160229)
廊坊市科技支撑计划项目(2018013136)
作者简介
通讯作者:褚雄兵,E-mail:lfsychu1985@qq.com。
