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目的 评估创伤后失血性休克重症病人的复苏指标。方法 前瞻法临床研究 1995年 1月至 1999年1月期间 ,进入外科重症加强医疗病区 (SICU)的连续 41例创伤后失血性低血容量休克病人。对所有病例常规采用止血、扩充血容量、儿茶酚胺类药物、稳定内环境等复苏措施 ,测定初始、12、2 4、48、72h血流动力学、氧动力学、血乳酸变化以及 2 4h内APACHEⅡ评分 ,比较存活组与死亡组资料。结果 (1)存活组 34例 (83 % ) ,死亡组 7例(17% ) ,均死于多器官功能衰竭 (MOF)。 (2 )从第二个 2 4小时开始 ,存活组CI、DO2 I、VO2 I平均水平显著高于死亡组。 (3)两组病人第一个 12小时的血乳酸均高于正常水平 ,死亡组显著高于存活组。存活组第一个 12小时开始降低 ,2 4小时至正常水平 ,与死亡组比较有显著差异 (P <0 0 1)。死亡组至 72小时仍显著保持高于正常血乳酸水平。 (4 )SvO2 在 2 4小时两组显示出显著差异 ,存活组显著高于死亡组 (P <0 0 5 )。 (5 )存活组MAP、CVP、PAWP的变化与死亡组比较无显著差异。 (6 )第一个 2 4小时的APACHEⅡ两组比较无显著差异。结论 血乳酸、SvO2 与DO2 I可作为失血性休克的重症病人早期评估复苏效果的良好指标 ,动态监测有较大意义。
Objective To evaluate the recovery index of patients with severe traumatic hemorrhagic shock. Methods Prospective clinical studies Between January 1995 and January 1999, 41 consecutive patients with post-traumatic hemorrhagic hypovolemic shock who entered the Severe Medical Intensive Surgery Unit (SICU) were enrolled. In all cases, hemostasis, blood volume expansion, catecholamines, stable internal environment and other resuscitation measures were routinely performed. The hemodynamics, oxygenation kinetics, blood lactic acid changes at 12,2,48,72h and APACHEⅡ Scoring, comparing survival and death data. Results (1) Survival group 34 patients (83%), death group 7 patients (17%), all died of multiple organ failure (MOF). (2) From the second 24 hours, the mean levels of CI, DO2 I and VO2 I in survival group were significantly higher than those in death group. (3) The first 12 hours of blood lactic acid in both groups were higher than normal, the death group was significantly higher than the survival group. The survival group began to decrease from the first 12 hours to the normal level from 24 hours to the normal level, which was significantly different from the death group (P <0.01). The death group remained significantly higher than normal blood lactate levels by 72 hours. (4) SvO2 showed a significant difference between the two groups at 24 hours, and the survival group was significantly higher than that of the death group (P <0.05). (5) There was no significant difference in the changes of MAP, CVP and PAWP between survivors and death groups. (6) The first 24 hours of APACHE Ⅱ no significant difference between the two groups. Conclusion Blood lactate, SvO2 and DO2 I can be used as a good indicator of early assessment of resuscitation in critically ill patients with hemorrhagic shock. Dynamic monitoring is of great significance.