不同液体复苏对创伤失血性休克患者抢救效果、电解质及免疫功能的影响

黄越

【摘要】 目的：觀察不同液体复苏对创伤失血性休克（THS）患者抢救效果、电解质及免疫功能的影响。方法：选取2017年1月-2019年12月在本院诊治的195例THS患者，根据液体复苏方式不同将其分为A组（限制性液体复苏，65例）、B组（高渗盐液体复苏，65例）、C组（常规液体复苏，65例）。对比三组24 h内死亡率及7 d内死亡率、电解质水平（Na、Cl、K、Mg）、免疫功能及并发症发生情况。结果：三组24 h内死亡率比较，差异无统计学意义（P>0.05）;A组与B组7 d内死亡率为4.62%与6.15%，均低于C组的18.46%（P<0.05）。复苏12 h后，三组各项电解质水平比较，差异均无统计学意义（P>0.05）。三组复苏12 h后K与Mg水平均低于复苏前，且A组与B组Na水平均高于复苏前（P<0.05）。复苏12 h后，三组CD4+、CD3+、CD4+/CD8+均较复苏前均升高，且A组与B组均高于C组（P<0.05）。A组与B组并发症发生率为11.29%与14.75%，均低于C组的32.08%（P<0.05）。结论：限制性及高渗盐液体复苏较常规液体复苏方式抢救THS患者效果更好，复苏后电解质紊乱情况较复苏前均有显著改善，可快速恢复机体细胞免疫功能，降低并发症发生率，临床应用价值较高。

【关键词】 液体复苏 创伤失血性休克 电解质 免疫功能

Effects of Different Fluid Resuscitation on Rescue Effect， Electrolyte and Immune Function in Patients with Traumatic Hemorrhagic Shock/HUANG Yue. //Medical Innovation of China， 2021， 18（12）： -163

[Abstract] Objective： To observe the effects of different fluid resuscitation on the rescue effect， electrolyte and immune function of patients with traumatic hemorrhagic shock （THS）. Method： A total of 195 patients with THS treated in our hospital from January 2017 to December 2019 were selected. They were divided into group A

（65 cases， limited fluid resuscitation）， group B （65 cases， hypertonic saline fluid resuscitation） and group C （65 cases， conventional fluid resuscitation） according to the different ways of fluid resuscitation. The mortality within 24 h and within 7 d， electrolyte level （Na， Cl， K， Mg）， immune function and the incidence of complications among three groups were compared. Result： There was no significant difference in mortality within 24 h among three groups （P>0.05）. The mortality rate within 7 d in group A and group B were 4.62% and 6.15%， both of which were lower than 18.46% in group C （P<0.05）. After 12 h of resuscitation， there were no significant differences in all electrolyte levels among three groups （P>0.05）. After 12 h of resuscitation， K and Mg levels in three groups were lower than those of before resuscitation， and Na levels in group A and group B were higher than those of before resuscitation （P<0.05）. After

12 h of resuscitation， CD4+， CD3+ and CD4+/CD8+ in three groups were increased compared with before resuscitation， and those in group A and group B were higher than those in group C （P<0.05）. The incidence of complications in group A and group B was 11.29% and 14.75%， both of which were lower 32.08% in group C （P<0.05）. Conclusion： Limited and hyperosmotic fluid resuscitation is more effective than conventional fluid resuscitation in rescuing THS patients. Electrolyte disorders after resuscitation are significantly improved compared with those before resuscitation， which can quickly restore the cellular immune function of the body， reduce the incidence of complications， and has high clinical application value.

[Key words] Fluid resuscitation Traumatic hemorrhagic shock Electrolyte Immune function

First-authors address： Foshan Fifth Peoples Hospital， Foshan 528211， China

doi：10.3969/j.issn.1674-4985.2021.12.038

创伤失血性休克（THS）是因各种创伤导致机体血液大量流失，致使各器官及组织灌注不足出现功能紊乱及受损情况[1-2]。THS导致的器官及外周组织灌注不足、微循环衰竭等可使全身出现炎症反应综合征（SIRS）及多器官功能不全综合征（MODS），且亦可造成机体温度过低、凝血功能障碍、代谢性酸中毒等，这三种因素会互相促进，发生恶性循环，又被称作致死三联征[3-4]。液体复苏是抢救THS的重要手段，传统方式是进行积极复苏方案，即短时间内进行大量补液使患者血压快速恢复正常[5]。但随着此方案的广泛应用，临床研究发现其导致的并发症较多，短时间内过度输液会加剧凝血失控、酸中毒、体温降低等，且可使出血量增加，导致死亡率增加[6]。随着限制性液体复苏及高渗盐液体复苏法方案被提出，可通过控制补液量、速度及浓度，使患者恢复血压的同时不至于过多失血，亦可纠正电解质紊乱情况[7]。鉴于……