限制性与积极性液体复苏对中重型并多发伤颅脑损伤患者凝血功能和预后的影响比较
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摘要
目的比较限制性液体复苏与积极性液体复苏对合并多发伤的中重型颅脑损伤患者凝血功能和预后的影响。方法选取医院2015年3月至2017年9月收治的合并多发伤的中重型颅脑损伤患者118例,根据复苏方式的不同分为对照组与观察组,各59例。观察组患者给予限制性液体复苏治疗,对照组采取积极性液体复苏治疗。结果两组患者入院时的平均动脉压(MAP)及休克指数、血红蛋白、损伤严重程度评分(ISS)和创伤严重指数(TSI)、格拉斯哥昏迷评分(GCS)相比无明显差异(P> 0. 05);治疗48 h后,观察组患者MAP、血压波幅及TSI均显著低于对照组(P <0. 05);观察组患者颅内血肿情况[血肿进展5例(8. 47%),进展后手术2例(3. 39%)],优于与对照组[血肿进展14例(23. 73%),进展后手术8例(13. 56%)](P <0. 05),且入院7 d时观察组的GCS高于对照组(P <0. 05);观察组患者的凝血指标下降幅度高于对照组(P <0. 05);随访3个月,观察组预后良好情况明显优于对照组(P <0. 05)。结论相比积极性液体复苏,限制性液体复苏对合并多发伤的中重型颅脑损伤患者,可有效改善其凝血功能障碍和休克状况,降低颅内再出血率,促进预后恢复。
Objective To compare the effects between limited fluid resuscitation and positive fluid resuscitation on coagulation function and prognosis in patients with moderate and severe craniocerebral injuries complicated with multiple injuries. Methods Totally 118 patients with moderate and severe craniocerebral injuries admitted to our hospital from March 2015 to September 2017 were selected and divided into the control group and the observation group according to the different resuscitation methods,59 cases in each group. The patients in the observation group were treated with limited fluid resuscitation,while the patients in the control group were treated with positive fluid resuscitation. Results When the patients were admitted to the hospital,there were no significant differences in the mean arterial pressure( MAP) and shock index,hemoglobin,injury severity score( ISS), trauma severity index( TSI),and Glasgow Coma Score( GCS) between the two groups( P > 0. 05). After 48 h of treatment,the MAP,amplitude of the blood pressure and TSI in the observation group were significantly lower than those in the control group( P < 0. 05). The condition of intracranial hematoma in the observation group [ 5 cases with hematoma progression( 8. 77%),2 cases( 3. 39%) requiring surgery after progression ] was better than that in the control group[14 cases with hematoma progression( 23. 73%),8 cases( 13. 56%) requiring surgery after progression]( P < 0. 05). 7 d after admission,the GCS in the observation group was higher than that of the control group( P < 0. 05). The decrease of coagulation index in the observation group was more significant than that in the control group( P < 0. 05). After 3 months of follow-up,the prognosis of the observation group was significantly better than that of the control group( P < 0. 05). Conclusion Compared with positive fluid resuscitation,limited fluid resuscitation can effectively improve coagulation disorder and shock status,reduce the rate of intracranial rebleeding and promote the recovery of prognosis in patients with moderate and severe craniocerebral injuries complicated with multiple injuries.
Objective To compare the effects between limited fluid resuscitation and positive fluid resuscitation on coagulation function and prognosis in patients with moderate and severe craniocerebral injuries complicated with multiple injuries. Methods Totally 118 patients with moderate and severe craniocerebral injuries admitted to our hospital from March 2015 to September 2017 were selected and divided into the control group and the observation group according to the different resuscitation methods,59 cases in each group. The patients in the observation group were treated with limited fluid resuscitation,while the patients in the control group were treated with positive fluid resuscitation. Results When the patients were admitted to the hospital,there were no significant differences in the mean arterial pressure( MAP) and shock index,hemoglobin,injury severity score( ISS), trauma severity index( TSI),and Glasgow Coma Score( GCS) between the two groups( P > 0. 05). After 48 h of treatment,the MAP,amplitude of the blood pressure and TSI in the observation group were significantly lower than those in the control group( P < 0. 05). The condition of intracranial hematoma in the observation group [ 5 cases with hematoma progression( 8. 77%),2 cases( 3. 39%) requiring surgery after progression ] was better than that in the control group[14 cases with hematoma progression( 23. 73%),8 cases( 13. 56%) requiring surgery after progression]( P < 0. 05). 7 d after admission,the GCS in the observation group was higher than that of the control group( P < 0. 05). The decrease of coagulation index in the observation group was more significant than that in the control group( P < 0. 05). After 3 months of follow-up,the prognosis of the observation group was significantly better than that of the control group( P < 0. 05). Conclusion Compared with positive fluid resuscitation,limited fluid resuscitation can effectively improve coagulation disorder and shock status,reduce the rate of intracranial rebleeding and promote the recovery of prognosis in patients with moderate and severe craniocerebral injuries complicated with multiple injuries.
引文
[1]万林,张瑞,张丽,等.不同液体复苏方式治疗多发伤合并休克患者效果及对炎性因子影响[J].临床误诊误治,2017,30(2):78-82.
[2]汤华林,王亮,刘振新,等.限制性液体复苏对多发性骨折合并创伤失血性休克患者免疫功能和炎症介质的影响[J].中国中西医结合急救杂志,2017,24(4):393-395.
[3]尹松涛,李玲雁,张国君,等.不同液体复苏对多发伤伴失血性休克患者凝血功能及髓系抑制性细胞数的影响[J].广西医科大学学报,2017,34(11):1611-1613.
[4]郭海军,王炜,俞斌,等.重型颅脑损伤合并多发伤140例的临床危险因素及预后分析[J].中国医师杂志,2017,19(6):928-930.
[5]郝继山,刘玉和,李鹤松,等.多发伤合并颅脑损伤患者颅内血肿进展相关因素分析[J].创伤外科杂志,2016,18(6):324-327.
[6]王松,苏菲,高海晓.中重型创伤性颅脑损伤患者凝血功能变化及对预后的影响[J].检验医学与临床,2017,14(10):1464-1466.
[7]张颖.早期限制性液体复苏抢救重度颅脑外伤合并失血性休克患者疗效分析[J].临床军医杂志,2017,45(4):412-415.
[8]张云.纠正亚低温联合限制性液体复苏在严重腹部创伤合并失血性休克中的应用[J].蚌埠医学院学报,2016,41(9):1204-1206.
[9]刘念,罗晓明,耿小平.限制性液体复苏对重症急性胰腺炎患者预后的影响[J].肝胆外科杂志,2016,24(2):117-119.
[10]覃智.重型颅脑创伤伴失血性休克患者的液体复苏研究[J].中国现代手术学杂志,2016,21(2):149-151.
[11]于鹏涛,刘暌,宋杰,等.多发伤合并中重型颅脑损伤凝血功能障碍的相关因素分析[J].创伤外科杂志,2017,19(4):270-272.
[12]梁建军.体温控制对重型颅脑损伤患者血清中S-100B蛋白、LDH表达及预后的影响[J].中国实验诊断学,2016,20(5):755-757.
[13]江亚.早期限制性液体复苏联合无痛胃镜对ICU肝硬化上消化道出血患者复苏成功率、止血效果及预后的影响[J].肝脏,2017,22(7):617-619.
[14]郭仕俊.早期限制性液体复苏在颅脑损伤伴失血性休克患者急救中的应用效果[J].实用心脑肺血管病杂志,2017,43(2):63-65.
[15]LI YK.Effect of clinical nursing pathway on neurological function and prognosis of patients with severe craniocerebral injury[J].Journal of Practical Gynecologic Endocrinology,2016,32(8):724-726.
[16]FENG J.Effect analysis of blood transfusion on coagulation function in patients with severe craniocerebral injury[J].Clinical Research&Practice,2017,12(7):641-643.
[17]邓石荣,黄学勤,甘国能,等.颅脑损伤合并多发伤病人预后的影响因素分析[J].中国微侵袭神经外科杂志,2017,22(2):76-77.
[2]汤华林,王亮,刘振新,等.限制性液体复苏对多发性骨折合并创伤失血性休克患者免疫功能和炎症介质的影响[J].中国中西医结合急救杂志,2017,24(4):393-395.
[3]尹松涛,李玲雁,张国君,等.不同液体复苏对多发伤伴失血性休克患者凝血功能及髓系抑制性细胞数的影响[J].广西医科大学学报,2017,34(11):1611-1613.
[4]郭海军,王炜,俞斌,等.重型颅脑损伤合并多发伤140例的临床危险因素及预后分析[J].中国医师杂志,2017,19(6):928-930.
[5]郝继山,刘玉和,李鹤松,等.多发伤合并颅脑损伤患者颅内血肿进展相关因素分析[J].创伤外科杂志,2016,18(6):324-327.
[6]王松,苏菲,高海晓.中重型创伤性颅脑损伤患者凝血功能变化及对预后的影响[J].检验医学与临床,2017,14(10):1464-1466.
[7]张颖.早期限制性液体复苏抢救重度颅脑外伤合并失血性休克患者疗效分析[J].临床军医杂志,2017,45(4):412-415.
[8]张云.纠正亚低温联合限制性液体复苏在严重腹部创伤合并失血性休克中的应用[J].蚌埠医学院学报,2016,41(9):1204-1206.
[9]刘念,罗晓明,耿小平.限制性液体复苏对重症急性胰腺炎患者预后的影响[J].肝胆外科杂志,2016,24(2):117-119.
[10]覃智.重型颅脑创伤伴失血性休克患者的液体复苏研究[J].中国现代手术学杂志,2016,21(2):149-151.
[11]于鹏涛,刘暌,宋杰,等.多发伤合并中重型颅脑损伤凝血功能障碍的相关因素分析[J].创伤外科杂志,2017,19(4):270-272.
[12]梁建军.体温控制对重型颅脑损伤患者血清中S-100B蛋白、LDH表达及预后的影响[J].中国实验诊断学,2016,20(5):755-757.
[13]江亚.早期限制性液体复苏联合无痛胃镜对ICU肝硬化上消化道出血患者复苏成功率、止血效果及预后的影响[J].肝脏,2017,22(7):617-619.
[14]郭仕俊.早期限制性液体复苏在颅脑损伤伴失血性休克患者急救中的应用效果[J].实用心脑肺血管病杂志,2017,43(2):63-65.
[15]LI YK.Effect of clinical nursing pathway on neurological function and prognosis of patients with severe craniocerebral injury[J].Journal of Practical Gynecologic Endocrinology,2016,32(8):724-726.
[16]FENG J.Effect analysis of blood transfusion on coagulation function in patients with severe craniocerebral injury[J].Clinical Research&Practice,2017,12(7):641-643.
[17]邓石荣,黄学勤,甘国能,等.颅脑损伤合并多发伤病人预后的影响因素分析[J].中国微侵袭神经外科杂志,2017,22(2):76-77.