常温液体与等体温液体在失血性休克病人抢救中的临床效果及对患者血流动力学影响

摘要/Abstract

摘要： 目的探究在失血性休克病人抢救中应用常温液体与等体温液体的临床效果及对患者血流动力学的影响。方法抽取徐州市第一人民医院于2021年2月~2022年7月收治的80例失血性休克患者,使用随机数表法将其分成对照组和试验组,每组40例。其中对照组患者应用常温液体治疗,试验组应用与患者体温相同的等体温液体治疗,对比两组患者临床效果及血流动力学指标。结果对比两组临床指标变化,试验组治疗后液体输入量、出血量、输血量均低于对照组,体温、尿量均高于对照组,差异有统计学意义（P<0.05）。对比两组患者治疗效果及不良反应发生情况,对照组治愈率低于试验组,不良反应发生率高于试验组,差异无统计学意义（P>0.05）。试验组治疗后临床红细胞压积（HCT）、平均动脉压（MAP）、中心静脉压（CVP）水平均高于对照组,心率（HR）水平低于对照组,差异有统计学意义（P<0.05）。结论在失血性休克病人的抢救中,应用等体温液体复苏治疗,有利于改善患者临床疗效,提升患者血流动力学指标,降低不良反应发生率,提升临床有效率。

关键词: 常温液体, 休克病人, 液体复苏, 等体温液体

Abstract: Objective To explore the clinical effects of normothermic and isothermal fluids in the treatment of patients with hemorrhagic shock, and to explore the influence of normothermic and isothermal fluids on the hemodynamics of patients. Methods 80 patients with hemorrhagic shock were selected from Xuzhou First People's Hospital from February 2021 to July 2022. They were divided into control group and test group using random number table method, with 40 patients in each group. The patients in the control group were treated with normal temperature liquid, and the patients in the test group were treated with the same body temperature liquid as the patient's temperature. The clinical effects and hemodynamic indexes of the two groups were compared. Results The changes of clinical indicators of the two groups were compared. After treatment, the fluid input, blood loss and blood transfusion of the patients in the test group were lower than those in the control group, and their body temperature and urine volume were higher than those in the control group, there was statistically significant difference between the two groups (P<0.05). The curative rate and adverse reaction rate in the control group were lower than those in the test group, and the adverse reaction rate was higher than that in the test group, there was no significant difference between the two groups (P>0.05). The clinical hematocrit (HCT) , mean arterial pressure (MAP) and central venous pressure pressure (CVP) in the test group were higher than those in the control group, the heart rate (HR) in the test group were lower than that in the control gruop, there was significant difference between the two groups (P<0.05). Conclusion In the rescue of patients with hemorrhagic shock, the application of isothermal fluid resuscitation can improve the clinical curative effect, improve the hemodynamics index, reduce the occurrence of adverse reactions and increase the clinical effective rate.

Key words: normal temperature liquid, shock patients, fluid resuscitation, isothermic liquid

中图分类号:

R605.971

王振. 常温液体与等体温液体在失血性休克病人抢救中的临床效果及对患者血流动力学影响[J]. 中华养生保健, 2022, 40(24): 19-22.

WANG Zhen. Clinical Effect of Normal Temperature Liquid and Isothermal Liquid in Rescuing Patients with Hemorrhagic Shock and its Influence on Hemodynamics[J]. ZHONGHUA YANGSHENG BAOJIAN, 2022, 40(24): 19-22.

参考文献

[1] Wang L, Lou J, Cao J, et al.Bicarbonate Ringer's solution for early resuscitation in hemorrhagic shock rabbits[J]. Annals of Translational Medicine, 2021, 9(6):462-462.
[2] Jiang H, Liu J, Xu Z, et al.Efficacy of Different Fluid Resuscitation Methods on Coagulation Function of Rats with Traumatic Hemorrhagic Shock[J]. Journal of Surgical Research, 2021, 260:259-266.
[3] 王京岚. 2014年欧洲危重病医学会(ESICM)休克及血流动力学监测共识解读[C]//中华医学会.中华医学会,2015.
[4] Beni C, Arbabi S, Robinson B, et al.Acute intensive care unit resuscitation of severely injured trauma patients: Do we need a new strategy[J]. The journal of trauma and acute care surgery, 2021, 91(6):1010-1017.
[5] Abdullah S, Packer J, Cotton-Betteridge A, et al.Estrogen Prevents Reactive Oxygen Species (ROS) Mediated Damage of the Endothelial Glycocalyx in Hemorrhagic Shock and Resuscitation[J]. J American College of Surgeons, 2021, 233(5):e204.
[6] Ziebart A, Ruemmler R, Mllmann C, et al.Fluid resuscitation-related coagulation impairment in a porcine hemorrhagic shock model[J]. PeerJ, 2020, 8(17):e8399.
[7] 庄华帅,范高文,钟昌会.目标导向与重症超声指导脓毒症休克患者液体管理的临床研究[J].中国急救复苏与灾害医学杂志,2021, 16(10):1129-11321137.
[8] 刘冬辉,刘超,文海燕,等.中心静脉压联合下腔静脉呼吸变异度在脓毒性休克患者液体复苏中的预测价值[J].川北医学院学报,2021, 36(11):1441-1444.
[9] 王丽娜,杨森.患者术中两种不同保温措施对围手术期冠状动脉搭桥低体温发生的效果观察[J].中国药物与临床,2021,21(16):2879-2882.
[10] 韩新平,王晓岐.强制空气加温对腹腔镜手术围术期低体温、并发症、机体应激及炎性反应的影响[J].医学临床研究,2022,39(2):255-258,262.
[11] 王博,马舰,刘雷.损伤控制手术联合不同液体复苏方式治疗对严重多发伤伴低血容量性休克患者NF-κB及血清和肽素水平的影响[J].河北医科大学学报,2020,41(3):331-335.
[12] 朱恒,李启梁,王振杰,等.不同液体限制性复苏对失血性休克病人血栓弹力图及凝血功能的影响[J].蚌埠医学院学报,2020,45(3):296-299.
[13] 王波,詹峰,胡志高.不同液体复苏对脓毒症休克患者血流动力学状态改善的差异性研究及对患者生存情况的影响[J].中国急救复苏与灾害医学杂志,2022,17(5):601-603,614.
[14] 李玲,杨丽娜,陈鹏,等.经食道多普勒超声指导的目标导向液体治疗在老年患者胸科手术中的应用效果[J].广西医学,2021,43(8):935-939.
[15] 陈东方,陈庆永,陈阳龙,等.限制性液体复苏联合体温管理在腹部严重创伤伴失血性休克患者中的应用效果[J].中华灾害救援医学,2020,8(1):52-54.
[16] 於江泉,郑瑞强,朱进,等.速度时间积分指导慢性阻塞性肺疾病合并感染性休克患者液体治疗的临床研究[J].中国全科医学,2021, 24(23):2945-2949.
[17] 翟建宾,张璐芳,于士昌,等.不同温度液体复苏对新西兰兔兰失血性休克模型肠系膜微循环功能及肠黏膜屏障功能影响[J].临床误诊误治,2021,11(34):102-106.
[18] 曹粒,眭建,叶向红.限制性液体复苏结合多模式疼痛管理对下肢骨折伴创伤失血性休克患者的影响[J].临床与病理杂志,2020,40(7): 1763-1770.