不同液体复苏方式对创伤性休克伴TIC患者的救治效果及免疫调节水平的影响

doi:10.3969/j.issn.1006-6233.2018.11.010

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Abstract Objective: To explore the clinical efficacy of damage control resuscitation (DCR) and active fluid resuscitation (AFR) in patients with traumatic shock and trauma induced coagulopathy (TIC). Methods: The clinical data of 92 patients with traumatic shock and TIC treated in our hospital from September 2011 to December 2017 were retrospectively analyzed. According to the fluid resuscitation strategy, the patients were divided into the amage control resuscitation group (DCR group, 47 cases) and active fluid resuscitation group (AFR group, 45 cases) . The activated partial thromboplastin time (APTT), international normalized ratio (INR), serum lactate (LAC), and hematocrit (HCT) in the two groups at 30 min before resuscitation and 6 h after resuscitation, and the two groups of shock index( SI), mean arterial pressure (MAP), blood pressure fluctuation amplitude, total fluid volume at 24 hours after resuscitation, platelet activating factor (PAF), Phospholipase A2 (PLA2) at 30min before resuscitation, 6h, 18h, and 36h after resuscitation, within 72h of recovery the complication rate and the survival rate at 1 week after resuscitation were compared. Results: There were no significant differences in MAP, SI, and injury severity score (ISS) between the two groups at admission (P>0.05). There was no significant difference in the APTT, INR, LAC, and HCT values between the two groups at 30 min before resuscitation (P>0.05); APTT, INR, LAC values were significantly lower,but HCT values were significantly higher in the DCR group than those in the AFR group at 6 hours 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 24 hours after resuscitation (P<0.05). There was no significant difference in PAF and PLA2 between the two groups at 30 minutes before and 18 hours after resuscitation (P>0.05). The PAF and PLA2 at 6 hours after resuscitation in the DCR group were significantly higher than those in the AFR group (P<0.05). The PAF and PLA2 at 36 hours after resuscitation were in the DCR group were significantly lower than those in the AFR group (P<0.05). After 72 hours of resuscitation, the incidence of ARDS, DIC, and MODS was significantly lower in the DCR group than in the AFR group, and the survival rate after one week of resuscitation was significantly higher in the DCR group than in the AFR group (P<0.05). Conclusion: Compared with AFR, DCR is effective in treating patients with traumatic shock and TIC, improving coagulation function, effectively correcting shock, stable blood pressure during resuscitation, low complication rate, high survival rate, and obvious clinical advantage; but in early resuscitation treatment AFR can effectively inhibit immunocytokines and inflammatory mediators and has a certain degree of immune regulation.

Key words： Trauma induced coagulopathy Damage control resuscitation Active fluid resuscitation Immunomodulatory Coagulation function

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2018.11.010 OR http://www.hbyxzzs.cn/EN/Y2018/V24/I11/1798

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