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目的:探讨两种液体复苏方法对院前创伤严重性出血性休克患者的作用。方法:采用回顾性分析方法,对2015年1月1日—12月31日由镇江市急救中心救治的42例严重出血性休克的外伤患者,在事故现场和入院后分别利用即时检验(POCT)进行动脉血气分析。所有患者依据复苏方法,分为传统液体复苏组和高渗性盐水组。比较两组患者的基本特征、创伤严重度、生化检测指标等。结果:全部42例中,其中22例(52.38%)接受了高渗性盐水复苏,20例(47.62%)接受了传统液体复苏,两组患者在年龄、基本病情方面无统计学差异。两组患者入院时的动脉收缩压和心率均较急救现场升高,但两组比较,差异不显著。高渗性盐水组碱剩余的变化为(-5.0±2.8),传统液体复苏组为(-1.9±3.3),差异显著(P<0.01)。入院时高渗性盐水组的pH值显著低于传统液体复苏组(P<0.01)。两组患者入院时的血红蛋白都降低,且高渗性盐水组比传统液体复苏组降低显著(P<0.05)。两组患者入院时的乳酸水平比较,差异不显著。结论:院前创伤严重性出血性休克采用传统液体复苏在纠正低血容量方面略优于高渗盐水复苏。
Objective: To investigate the effects of two fluid resuscitation methods on patients with severe hemorrhagic shock before hospitalization. Methods: Forty-two patients with severe hemorrhagic shock who were treated by Zhenjiang Emergency Center from January 1, 2015 to December 31, 2015 were retrospectively analyzed. The patients were divided into two groups randomly: live test (POCT) Arterial blood gas analysis. All patients according to the recovery method, divided into traditional liquid resuscitation group and hypertonic saline group. Compare the basic characteristics of two groups of patients, the severity of trauma, biochemical test indicators. RESULTS: Twenty-two of the 42 patients (52.38%) underwent hypertonic saline resuscitation and 20 (47.62%) received conventional fluid resuscitation. There was no significant difference in age and basic disease between the two groups. The systolic blood pressure and heart rate of the two groups were higher than those of the first aid hospital, but the difference was not significant between the two groups. In the hypertonic saline group, the change of alkaline surplus was (-5.0 ± 2.8) and that in the traditional liquid resuscitation group was (-1.9 ± 3.3), respectively (P <0.01). The pH of hypertonic saline group at admission was significantly lower than that of the traditional liquid resuscitation group (P <0.01). Hemoglobin at admission was lower in both groups, and the hypertonic saline group was significantly lower than the traditional liquid resuscitation group (P <0.05). There was no significant difference in lactate levels between the two groups on admission. CONCLUSIONS: Prehospital traumatic hemorrhagic shock is slightly better than hypertonic saline in correcting for hypovolemia with conventional fluid resuscitation.