Lu Yan, Liu Liping, Wang Jing, Cui Limin
Yan Lu, Binzhou People's Hospital, Binzhou, Shandong, 256610, China.
Liping Liu, Binzhou Hospital of Traditional Chinese Medicine, Binzhou, Shandong, 256600, China.
Pak J Med Sci. 2018 Sep-Oct;34(5):1120-1124. doi: 10.12669/pjms.345.15465.
To explore the effectiveness of controlled blood pressure elevation and limited fluid resuscitation in treating patients with multiple injuries in combination with shock in Intensive Care Unit (ICU).
One hundred and sixty-four patients with multiple injuries in combination with shock who were admitted into the ICU of the hospital between June 2014 and November 2017 were selected and divided into an observation group and a control group using random number table, 82 each group. Controlled blood pressure elevation was given to both groups. Moreover, the control group was given conventional fluid resuscitation, while the observation group was given limited fluid resuscitation. The treatment effectiveness and complications were compared between the two groups.
The resuscitation time, post-resuscitation PT and post-resuscitation C-reactive protein level of the observation group were significantly lower than those of the control group (P<0.05). The post-resuscitation hemoglobin level of the observation group was significantly higher than that of the control group (P<0.05). The lactate clearance rate (LCR) of the observation group was (0.22±0.01) and (0.37±0.06) respectively three and six hours after fluid resuscitation, which was remarkably different with that of the control group ((0.27±0.03) and (0.51±0.08)) (P<0.05), but the difference became insignificant 24 h after fluid resuscitation (P>0.05). The observation group had significantly lower incidences of complications such as disseminated intravascular coagulation, respiratory distress syndrome and multiple organ dysfunction syndromes of the observation group and death rate than the control group, and the differences had statistical significance (P<0.05).
Controlled blood pressure elevation in combination with limited fluid resuscitation is more effective than conventional fluid resuscitation in the treatment of patients with multiple injuries and shock in ICU as it can shorten recovery time, improve microcirculation perfusion and prognosis, and reduce related complications and fatality rate.
探讨控制性血压升高联合限制性液体复苏在重症监护病房(ICU)治疗多发伤合并休克患者中的有效性。
选取2014年6月至2017年11月期间收治于本院ICU的164例多发伤合并休克患者,采用随机数字表法分为观察组和对照组,每组82例。两组均给予控制性血压升高。此外,对照组给予传统液体复苏,观察组给予限制性液体复苏。比较两组的治疗效果及并发症情况。
观察组的复苏时间、复苏后凝血酶原时间(PT)及复苏后C反应蛋白水平均显著低于对照组(P<0.05)。观察组复苏后的血红蛋白水平显著高于对照组(P<0.05)。液体复苏后3小时和6小时,观察组的乳酸清除率(LCR)分别为(0.22±0.01)和(0.37±0.06),与对照组((0.27±0.03)和(0.51±0.08))相比差异有统计学意义(P<0.05),但液体复苏24小时后差异无统计学意义(P>0.05)。观察组弥散性血管内凝血、呼吸窘迫综合征、多器官功能障碍综合征等并发症发生率及死亡率均显著低于对照组,差异有统计学意义(P<0.05)。
控制性血压升高联合限制性液体复苏治疗ICU多发伤合并休克患者比传统液体复苏更有效,可缩短恢复时间,改善微循环灌注及预后,降低相关并发症及死亡率。