摘要
目的观察积极液体复苏(active liquid resuscitation,AFR)与损伤控制复苏(damage control resuscitation,DCR)对创伤性休克伴创伤性凝血功能异常(trauma induced coagulopathy,TIC)患者凝血功能、免疫调节及疗效的影响。方法回顾性分析94例创伤性休克伴TIC患者的临床资料,依据液体复苏策略分为积极液体复苏组(AFR组,46例)和损伤控制复苏组(DCR组,48例),对复苏前20 min和复苏后12 h 2组国际标准化比值(international normalized ratio,INR)、凝血酶原时间(prothrombin time,PT)、活化部分凝血酶原时间(activated partial thromboplastin time,APTT)、D-二聚体,复苏后18 h 2组休克指数(shock index,SI)、平均动脉压(mean artery pressure,MAP)、血压波动幅度、总补液量,复苏前20 min和复苏后12 h、24 h、48 h 2组磷脂酶A2(phospholipase A2,PLA2)、血小板活化因子(platelet activating factor,PAF),复苏后96 h并发症发生率,复苏后1周存活率等指标进行比较。结果入院时2组MAP、SI、创伤严重度评分(Injury Severity Score,ISS)差异均无统计学意义(P>0.05)。2组复苏前20 min APTT、INR、PT、D-二聚体值差异均无统计学意义(P>0.05);复苏后12 h DCR组APTT、INR、PT、D-二聚体值明显低于AFR组(P<0.05)。复苏后24 h DCR组MAP、血压波动幅度、SI值、总补液量明显低于AFR组(P<0.05)。2组复苏前20 min和复苏后24 h PLA2、PAF差异均无统计学意义(P>0.05);复苏后12 h DCR组PLA2、PAF明显高于AFR组,复苏后48 h DCR组PLA2、PAF明显低于AFR组(P<0.05)。复苏后96 h DCR组并发症发生率明显低于AFR组,复苏后1周DCR组存活率明显高于AFR组(P<0.05)。结论DCR救治创伤性休克伴TIC患者,明显改善凝血功能指标,有效纠正休克,复苏期间血压稳定,并发症发生率低,存活率较高,与AFR相比临床疗效明显;但AFR在复苏治疗早期能有效抑制免疫细胞因子、炎症介质,具有一定的免疫调节作用。
Objective To investigate the effects of active fluid resuscitation(AFR)and damage control resuscitation(DCR)on coagulation function,immune regulation,and therapeutic efficacy in patients with traumatic shock and trauma induced coagulopathy(TIC).Methods The clinical data of 94 patients with traumatic shock and TIC treated were retrospectively analyzed.According to the fluid resuscitation strategy,the patients were divided into the amage control resuscitation group(DCR group,48 cases)and active fluid resuscitation group(AFR group,46 cases).The international normalized ratio(INR),prothrombin time(PT),activated partial prothrombin time(APTT),D-dimer in two groups at 20 min before resuscitation and 12 h after resuscitation,and the two groups of shock index(SI),mean arterial pressure(MAP),blood pressure fluctuation amplitude,total fluid volume at 18 h after resuscitation,Phospholipase A2(PLA2),platelet activating factor(PAF)at 20 min before resuscitation,12 h,24 h,and 48 h after resuscitation,within 96 h of recovery the complication rate and the survival rate at 1 week after resuscitation were compared.Results There was no significant difference in MAP,SI,and Injury Severity Score(ISS)between two groups at admission(P>0.05).There was no significant difference in the INR,APTT,PT,and D-dimer values between the two groups at 20 min before resuscitation(P>0.05).INR,APTT,PT,and D-dimer values were significantly lower in the DCR group than those in the AFR group at 12 h after resuscitation(P<0.05).The MAP,blood pressure fluctuation amplitude,SI value,and total rehydration dose in the DCR group were significantly lower than those in the AFR group at 18 h after resuscitation(P<0.05).There was no significant difference in PLA2 and PAF between two groups at 20 min before and 24 h after resuscitation(P>0.05).The PLA2 and PAF at 12 h after resuscitation in the DCR group were significantly higher than those in the AFR group(P<0.05).The PLA2 and PAF at 48 h after resuscitation were in the DCR group were significantly lower than those in the AFR group(P<0.05).After 96 h of resuscitation,the complication rate in the DCR group was significantly lower than in the AFR group,and the survival rate after one week of resuscitation in the DCR group was significantly higher than in the AFR group(P<0.05).Conclusion DCR treatment of traumatic shock with TIC patients,significantly improved coagulation parameters,effective correction of shock,stable blood pressure during resuscitation,low incidence of complications,high survival rate,clinical efficacy compared with AFR significantly,but AFR can be early in resuscitation treatment effective inhibition of immune cytokines,inflammatory mediators,has a certain degree of immune regulation.
作者
严晓薇
李小东
李素清
滑立伟
段立娟
赵静媛
YAN Xiao-wei;LI Xiao-dong;LI Su-qing;HUA Li-wei;DUAN Li-juan;ZHAO Jin-yuan(Department of Critical Care Medicine,Affiliated Hospital of Chengde Medical College,Hebei Province,Chengde 067000,China)
出处
《河北医科大学学报》
CAS
2019年第11期1279-1284,共6页
Journal of Hebei Medical University
基金
承德市科学技术研究与发展计划项目(201801A038)
