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目的:研究限制性液体复苏对多发伤并出血未控制性休克术前的治疗效果,探讨最佳的液体复苏方法。方法:选择2014年1月-2016年5月间经我院急诊科抢救的多发伤合并出血未控制性休克病例204例,根据液体复苏方法的不同分为充分液体复苏组(A组)和限制性液体复苏组(B组),B组又根据复苏中所选液体补液速度的不同分为B1组和B2组,比较不同复苏组间存活率、死亡率、MODS的发生率、碱剩余及血清乳酸值。结果:A组B组血气碱剩余值(BE)、血清乳酸值复苏后明显改善(P<0.05),B组改善程度更为显著(P<0.05)。B组、B1组和B2组死亡率和MODS发生率明显低于于A组,存活率明显高于A组(P<0.05);B1组和B2组在存活率、死亡率、MODS发生率上无显著性差异,但B1组输液总量明显少于B2组。结论:对于严重多发伤合并出血未控制性休克患者,正确及时的液体复苏能够有效恢复血容量,为后续治疗营造良好条件。早期采用限制性液体复苏能够提高患者的存活率,降低死亡率及MODS的发生率。
OBJECTIVE: To study the effect of restrictive fluid resuscitation on preoperative management of multiple trauma and uncontrolled hemorrhage and to explore the best liquid resuscitation method. Methods: A total of 204 cases of multiple uncontrolled hemorrhagic uncontrolled shock rescued by emergency department of our hospital from January 2014 to May 2016 were divided into adequate liquid resuscitation group (A group) and restriction according to the method of liquid resuscitation The group B and group B were divided into group B1 and group B2 according to the rate of fluid replacement in the resuscitation group. The survival rates, mortality, the incidence of MODS, alkali excess and serum Lactic acid value. Results: The serum creatine base excess (BE) and serum lactate in group A were significantly improved after resuscitation (P <0.05), and the improvement in group B was more significant (P <0.05). The mortality and the incidence of MODS in group B, group B1 and group B2 were significantly lower than those in group A, and the survival rates were significantly higher than those in group A (P <0.05). The survival rates, mortality and MODS in group B1 and group B2 No significant difference, but the total infusion group B1 was significantly less than the B2 group. Conclusion: For patients with severe multiple injuries and uncontrolled hemorrhage, correct and timely liquid resuscitation can effectively restore blood volume and create favorable conditions for subsequent treatment. Early use of restrictive fluid resuscitation can improve patient survival, reduce mortality and MODS incidence.