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目的:探讨限制性液体复苏联合血液回收机自体血回输技术在宫外孕破裂失血性休克患者的应用价值及安全性。方法:采用前瞻性临床随机对照研究的方法,将2012年1月~2014年10月在该院住院的57例失血性休克宫外孕患者分为两组,A组(30例)采用限制性液体复苏联合术中回收自体血,回输后血红蛋白Hb<65g/L时输异体血;B组(27例)采用常规液体复苏,根据患者的出血情况决定异体血输入量。连续监测MAP、CVP、HR、ECG,记录平均输液量、回输自体血量、输异体血量、输血不良反应、术后发热率、术后乳酸(Lac)升高发生率、平均住院日;观察入院时(T0)、止血前(T1)、输血后(T2)、术后24 h(T3)的Hb、Hct、Plt、WBC、APTT、PT、Lac。结果:与B组比较,A组的平均输液量、异体输血量明显减少,平均住院日缩短,差异有统计学意义(P<0.05);两组T1比较,A组较B组Hb、Hct、Plt升高,APTT、PT下降,其中Hct、APTT两组比较差异有统计学意义(P<0.05);两组T2、T3比较,A组较B组Hb、Hct、Plt明显升高,T2时点A组较B组PTT、PT明显下降,T3时点A组较B组WBC明显下降,差异均有统计学意义(P<0.05)。结论:限制性液体复苏联合血液回收机回输自体血技术在宫外孕破裂失血性休克的救治中取得良好疗效,提供安全、方便、有效的血液保护,节约血源,降低并发症的发生率。
OBJECTIVE: To investigate the value and safety of restrictive fluid resuscitation combined with blood recovery autologous blood transfusion in patients with hemorrhagic shock ruptured by ectopic pregnancy. Methods: Fifty-seven patients with hemorrhagic shock ectopic pregnancy hospitalized in our hospital from January 2012 to October 2014 were divided into two groups according to a prospective clinical randomized controlled study. Group A (30 patients) were treated with restrictive fluid resuscitation Allogeneic blood was collected during the operation, and allogeneic blood was transfused when hemoglobin Hb <65g / L after transfusion. Conventional fluid resuscitation was performed in group B (27 patients). Continuous monitoring of MAP, CVP, HR, ECG, recording of average transfusion volume, transfusion of autologous blood volume, transfusion of transfusion volume, transfusion adverse reactions, postoperative fever rate, postoperative lactic acid (Lac) incidence and average length of stay; Hb, Hct, Plt, WBC, APTT, PT and Lac were observed before admission (T0), before hemostasis (T1), after transfusion (T2), and after 24 h (T3). Results: Compared with group B, the average volume of transfusion and allogeneic transfusion decreased significantly in group A, and the average length of stay was shorter, the difference was statistically significant (P <0.05). The level of Hb, Hct, (P <0.05). Compared with T2 and T3, the Hb, Hct, Plt of group A were significantly higher than that of group B, The PTT and PT in point A group were significantly lower than those in group B, and the WBC in A group was significantly lower than that in B group at T3 point (P <0.05). Conclusion: Restricted liquid resuscitation combined with blood transfusion machine autologous blood transfusion in the treatment of ruptured hemorrhagic shock in ectopic pregnancy achieved good efficacy, to provide safe, convenient and effective blood protection, reduce blood loss and reduce the incidence of complications.