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

朱恒; 李启梁; 王振杰; 纪忠; 邱兆磊

doi:10.13898/j.cnki.issn.1000-2200.2020.03.004

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

Effects of different fluid restriction resuscitation on coagulation function and thromboelasticdiagram in patients with hemorrhagic shock

摘要

摘要:
目的探讨不同液体限制性复苏对创伤失血性休克病人（HS）的抢救效果及对凝血功能（凝血酶原时间、活化部分凝血活酶时间）和血栓弹力图凝血休克时间（K）、凝血反应时间（R）、最大凝块强度（MA）等的影响。
方法选取40例HS病人作为研究对象，随机分为醋酸钠林格液组（AR组）和乳酸钠林格液组（LR组），各20例。AR组复苏液体采用醋酸钠林格液，LR组复苏液体采用乳酸钠林格液，复苏方法均采用限制性液体复苏，分别于开始复苏前及复苏1 h后抽取外周静脉血液样本，通过比较2组病人外周血的凝血功能和血栓弹力图，观察2种液体的复苏效果。
结果复苏开始前，2组病人外周血的凝血功能和血栓弹力图差异均无统计学意义（P>0.05）。复苏1 h后，与LR组相比，AR组病人外周血的凝血酶时间和血栓弹力图的K值差异有统计学意义（P < 0.05）。
结论相比乳酸钠林格液，醋酸钠林格液复苏HS病人，能更好地控制病人的凝血功能及血栓弹力图的相关参数，使得HS病人的液体复苏在早期能取得较好疗效。

Abstract:
ObjectiveTo explore the rescue effect of different restrictive fluid resuscitation on traumatic hemorrhagic shock patients (HS) and the effects on coagulation function (prothrombin time, activated partial thrombin time) and thromboelastic diagram (K, R, MA, etc.).
MethodsForty HS patients were randomly divided into sodium acetate linge fluid group(AR group) and sodium lactate linge fluid group(LR group), with 20 cases in each group.AR group recovery liquid using sodium acetate ringer's solution, LR group recovery liquid using sodium lactate ringer's solution, adopt restrictive liquid recovery, recovery method respectively and recovery for 1 hour prior to the recovery after extracting peripheral venous blood samples, by comparing the two groups of patients with peripheral blood coagulation function and thrombus elastic figure, to observe the recovery effect of two kinds of liquid.
ResultsBefore the onset of resuscitation, there was no statistically significant difference between the two groups in peripheral blood clotting function and thromboelastic diagram (P>0.05).One hour after resuscitation, compared with the LR group, there were statistically significant differences in parameters related to thrombin time and kinetics time in the AR group(P < 0.05).
ConclusionsCompared with sodium lactate ringer's solution, sodium acetate ringer's solution for resuscitation of HS patients can better control the coagulation function of patients and related parameters of thromboelastic diagram, so that the liquid resuscitation of HS patients can achieve curative effect in the early stage.

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