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目的 探讨限制性液体复苏对出血未控制性休克后续救治的影响。方法 应用脾组织和血管损伤制作重度未控制出血性休克模型 ,比较早期限制液体复苏 [平均动脉压 (MAP)分别维持在 4 0mmHg(NS4 0组 ,1mmHg =0 .133kPa)、5 0mmHg(NS5 0组 )和 6 0mmHg(NS6 0组 ) ]和大量液体复苏 [MAP分别维持在 80mmHg(NS80组 )和 10 0mmHg(NS10 0组 ) ]对MAP、血乳酸 (BL)、红细胞压积 (HCT)、出血量、输液量及存活率的影响。结果 NS4 0、NS5 0和NS6 0组的出血量、液体用量和存活率明显低于NS80和NS10 0组 (P均 <0 .0 5 ) ;伤后4 5min ,NS80和NS10 0组HCT明显低于NS4 0、NS5 0和NS6 0组 (P均 <0 .0 5 ) ;伤后 4 0 5min ,NS80和NS10 0组的HCT明显低于NS5 0和NS6 0组 ,MAP明显低于NS4 0、NS5 0和NS6 0组 ,血乳酸明显高于NS4 0、NS5 0和NS6 0组 (P均 <0 .0 5 )。结论 在出血未控制条件下 ,早期限制性液体复苏可明显降低出血量 ,减轻酸中毒 ,为后续救治创造条件 ,并有利于最终存活率的提高
Objective To investigate the effect of restrictive fluid resuscitation on the follow-up treatment of uncontrolled hemorrhage. Methods Severe uncontrolled hemorrhagic shock model was established by using spleen tissue and blood vessel injury. Compared with the earlier limitation of liquid resuscitation [mean arterial pressure (MAP) were maintained at 40 mmHg (NS4 0 group, 1 mmHg = 0.133 kPa) and 50 mmHg (BL), hematocrit (HCT), blood pressure (LPS), blood pressure (LPS) Bleeding volume, infusion volume and survival rate. Results The amount of bleeding, fluid usage and survival rate in NS4 0, NS5 0 and NS6 0 groups were significantly lower than those in NS80 and NS10 0 groups (all P <0.05). At 45 min after injury, HCTs in NS80 and NS10 0 groups were significantly lower The NSC 0 and NS 60 groups showed significantly lower HCT than NS 50 and NS 60 groups, and the MAP was significantly lower than that of NS 4 0 group (P 0. 05) The levels of serum lactate in NS5 0 and NS6 0 groups were significantly higher than those in NS4 0, NS5 0 and NS6 0 groups (all P <0.05). Conclusion In uncontrolled bleeding, early resuscitation of restrictive fluid can significantly reduce the amount of bleeding, reduce acidosis, to create conditions for subsequent treatment, and is conducive to the final survival rate increased