内科

目的探讨不同液体复苏方案治疗急诊创伤失血性休克患者的临床效果。方法选取2019年1月至2020年1月我院急诊科收治的60例创伤失血性休克患者为研究对象，利用随机数字法将患者分为限制组、高渗盐组及常规组各20例。常规组患者采用常规液体复苏方案，限制组患者采用限制性液体复苏方案，高渗盐组患者采用高渗盐液体复苏方案。比较三组患者的急诊抢救效果、并发症发生率、凝血功能、电解质变化情况。结果三组患者的24 h内病死率、7 d内病死率、并发症发生率比较，差异无统计学意义（P＞0.05）。复苏1 h后，限制组、高渗盐组患者的凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）明显短于常规组，差异有统计学意义（P＜0.05）；限制组患者的PT、APTT与高深组患者比较，差异无统计学意义（P＞0.05）。复苏前，三组患者的血钾、血钠水平比较，差异无统计学意义（P＞0.05）；复苏1 h后，三组患者的血钾水平均显著降低，血钠水平显著升高，与复苏前比较差异有统计学意义（P＜0.05）；复苏1 h后，三组患者的血钾、血钠水平比较，差异无统计学意义（P＞0.05）。结论常规液体、限制性液体、高渗盐液体复苏治疗均可有效改善急诊创伤失血性休克患者的凝血功能及电解质水平，限制性液体、高渗盐液体复苏的效果较好，不良反应发生率较低。

ObjectiveTo explore the clinical effect of different fluid resuscitation programs in the treatment of emergency traumatic hemorrhagic shock patients. MethodsA total of 60 patients with traumatic hemorrhagic shock admitted to the emergency department of our hospital from January 2019 to January 2020 were selected as the research objects, and they were divided into restriction group, hypertonic salt group and conventional group according to the random number method, with 20 cases in each group. The patients in the conventional group were given conventional fluid resuscitation program, while the patients in the restriction group were treated with restrictive fluid resuscitation program, and hypertonic salt group was resuscitated with hypertonic saline program. The emergency rescue effect, incidence of complications, coagulation function and electrolyte changes were compared among the three groups. ResultsThere were no statistically significant differences in the fatality rate within 24 hours, the fatality rate within 7 days and the incidence of complications among the three groups (P＞0.05). After 1 hour of resuscitation, prothrombin time (PT) and activated partial thromboplastin time (APTT) in the restriction group and hypertonic salt group were significantly shorter than those in the conventional group, with statistically significant differences (P＜0.05). There were no statistically significant differences in PT and APTT between the restriction group and the hypertonic salt group (P＞0.05). Before resuscitation, there were no statistically significant differences in serum potassium and serum sodium levels among the three groups (P＞0.05). After 1 hour of resuscitation, the serum potassium levels decreased significantly, and the serum sodium levels increased significantly in all three groups, and there were statistically significant differences compared with those before resuscitation (P＜0.05). After 1 hour of resuscitation, there were no statistically significant differences in serum potassium and serum sodium levels among the three groups (P＞0.05). ConclusionConventional fluid, restrictive fluid, and hypertonic saline fluid resuscitation treatments are effective in improving coagulation and electrolyte levels in patients with emergency traumatic hemorrhagic shock, and have better outcomes of restrictive fluid and hypertonic saline fluid resuscitation with a lower incidence of adverse effects.