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目的探讨高渗盐水联合限制性液体复苏对创伤失血性休克患者的临床价值。方法 90例患者随机分为三组:限制性液体复苏组(组1)、高渗盐水+限制性液体复苏组(组2)、正压复苏组(组3),每组30例。三组患者均输注乳酸林格氏液及羟乙基淀粉,两者比例2∶1~3∶1。组3目标血压为平均动脉压(MAP)>80 mm Hg,组1及组2目标血压为MAP 60 mm Hg左右。比较三组的补液量、PT、APTT、血红蛋白、碱剩余、乳酸、体温、TNF-α、MODS发病率、病死率。结果 1三组的一般资料无统计学差异(P>0.05)。2三组患者的补液量、输注红细胞、PT、APTT、BE、乳酸以及TNF-α水平均有统计学差异(P<0.05),组3显著高于组1、组2,组1显著高于组2(P<0.05)。3三组的血红蛋白浓度有统计学差异(P<0.05),组3显著低于组1、组2(P<0.05),组1、组2间无显著差异(P>0.05)。4三组体温有统计学差异(P<0.05),组3显著低于组1、组2,组1显著低于组2(P<0.05)。5三组患者MODS及死亡率有显著差异(P<0.05),组3显著高于组2(P<0.05),组1、组2间无显著差异(P>0.05)。结论限制性液体复苏联合高渗盐水复苏作用优于单纯限制性液体复苏及正压复苏。
Objective To investigate the clinical value of hypertonic saline combined with restrictive fluid resuscitation in patients with traumatic hemorrhagic shock. Methods Ninety patients were randomly divided into three groups: restricted fluid resuscitation group (group 1), hypertonic saline + restrictive fluid resuscitation group (group 2), and positive pressure resuscitation group (group 3), with 30 patients in each group. Three groups of patients were infused lactated Ringer’s solution and hydroxyethyl starch, the ratio of 2: 1 ~ 3: 1. The target blood pressure in group 3 was MAP 80 mm Hg, and the target BP in group 1 and group 2 was MAP 60 mm Hg. The three groups of fluid volume, PT, APTT, hemoglobin, alkaline excess, lactic acid, body temperature, TNF-α, MODS morbidity and mortality were compared. Results 1 three groups of general information was no significant difference (P> 0.05). (P <0.05). The levels of fluid infusion, erythrocyte transfusion, PT, APTT, BE, lactate and TNF-α levels in three groups were significantly different (P <0.05) In group 2 (P <0.05). (P <0.05). The level of hemoglobin in group 3 was significantly lower than that in group 1 and group 2 (P <0.05). There was no significant difference between group 1 and group 2 (P> 0.05). There was a significant difference in body temperature between the three groups (P <0.05), group 3 was significantly lower than group 1, group 2, group 1 was significantly lower than group 2 (P <0.05). There were significant differences in MODS and mortality between the three groups (P <0.05), group 3 was significantly higher than group 2 (P <0.05), and there was no significant difference between group 1 and group 2 (P> 0.05). Conclusion The resuscitation by restrictive fluid resuscitation combined with hypertonic saline is better than that by simple fluid resuscitation and positive pressure resuscitation.