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    限制性液体复苏对失血性休克院前急救患者血气指标与凝血功能的影响

    Effects of limited-volume fluid resuscitation on blood gas and coagulation of hemorrhagic shock patients during pre-hospital emergency treatment

    • 摘要: 目的 探讨限制性液体复苏对失血性休克院前急救患者血气指标与凝血功能的影响。方法 选取2015年8月—2017年8月上海市松江区医疗急救中心送往急诊科进行院前急救的112例失血性休克患者,分为研究组和对照组(n=56),对照组采用常规液体复苏,研究组采用限制性液体复苏。对比2组患者进入急诊时及进入急诊后60、120、180 min的血气指标与凝血功能的差异。 结果 研究组实施院前急救限制性液体复苏后各时间点动脉血氧分压(PaO2)、剩余碱(BE)测量值显著高于对照组(P<0.05),血清乳酸(BL)测量值显著低于对照组(P<0.05);研究组实施院前急救限制性液体复苏后60、120、180 min测定的凝血酶原时间(PT)、部分凝血活酶时间(APTT)显著低于对照组(P<0.05), 血小板(PLT)计数显著高于对照组(P<0.05);研究组实施院前急救后弥散性血管内凝血(DIC)发生率、病死率显著低于对照组(P<0.05)。结论 采用限制性体液复苏对失血性休克患者进行院前急救,能更好地改善患者血气指标、凝血功能,降低DIC的发生率和病死率。

       

      Abstract: Objective To investigate the effects of limited-volume fluid resuscitation on blood gas and coagulation of hemorrhagic shock patients in pre-hospital emergency treatment. Methods A total of 112 hemorrhagic shock patients who received pre-hospital emergency treatment in Medical Emergency Center of Songjiang District from August 2015 to August 2017 were enrolled. They were divided into two groups (n=56): a study group and a control group. The control group underwent routine fluid resuscitation, while the study group received limited-volume fluid resuscitation. Both groups were compared for blood gas indexes and coagulation function when entry into emergency department and 60 min, 120 min and 180 min after treatment. Results After limited-volume fluid resuscitation during pre-hospital emergency treatment, the study group presented remarkable increases in arterial partial pressure of oxygen (PaO2) and base excess (BE) (P<0.05), as well as decreases in blood lactic acid(BC), compared with those in the control group (P<0.05). Furthermore, the study group showed remarkable decreases in prothrombin time (PT) and activated partial thromboplastin time (APTT) 60 min, 120 min and 180 min after limited-volume fluid resuscitation (P<0.05), as well as increases in PLT counts compared with the control group (P<0.05). After pre-hospital emergency treatment, the study group produced decreases in the incidence of disseminated intravascular coagulation (DIC) and mortality compared with the control group (P<0.05). Conclusions The use of limited-volume fluid resuscitation for pre-hospital emergency treatment can improve blood gas index and coagulation function, and reduce the incidence of DIC and mortality in patients with hemorrhagic shock.

       

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