碳酸氢钠林格液限制性复苏对创伤失血性休克内环境的影响

赵德俊; 张福龙; 徐志鹏; 宋琦; 姜海; 李磊; 邱兆磊; 纪忠; 王振杰

doi:10.13898/j.cnki.issn.1000-2200.2021.04.007

碳酸氢钠林格液限制性复苏对创伤失血性休克内环境的影响

Effect of limited resuscitation with sodium bicarbonate Ringer's solution on the internal environment of traumatic hemorrhagic shock

摘要

摘要:
目的比较乳酸钠林格液、碳酸氢钠林格液限制性复苏对创伤失血性休克病人外周血细胞因子、动脉血乳酸值、血小板计数及凝血功能，为筛选相对理想的复苏液体提供参考。
方法采用前瞻性对照研究，纳入48例创伤失血性休克住院病人，采用随机数据表法分为观察组和对照组，各24例。其中，观察组应用碳酸氢钠林格液进行复苏，对照组应用乳酸钠林格液进行复苏，2组均采用限制性补液复苏策略。分别测定复苏前、复苏1 h后病人的外周血中白细胞介素（IL）-4、IL-6、IL-10、肿瘤坏死因子（TNF）-α水平以及动脉血的乳酸值、外周血小板计数、血浆凝血酶原时间、纤维蛋白原水平。
结果复苏1 h后，观察组除TNF-α，其余因子均较复苏前显著增高（P < 0.01），对照组只有IL-6和IL-10较复苏前显著增加（P < 0.01）。观察组复苏1 h后外周血细胞因子IL-4和IL-10水平高于对照组，IL-6和TNF-α低于对照组（P < 0.05）。复苏后1 h后，观察组动脉血乳酸值显著低于对照组（P < 0.01），而血小板计数、血浆凝血酶原时间、纤维蛋白原比较差异无统计学意义（P>0.05）。
结论碳酸氢钠林格液早期复苏创伤失血性休克病人能更好地抑制外周血中炎症因子的表达，并且能够更好地降低血乳酸值，比乳酸钠林格液复苏更有优势。

Abstract:
ObjectiveTo compare the effects of limited resuscitation with sodium lactate Ringer's solution and sodium bicarbonate Ringer's solution on peripheral blood cytokines, arterial blood lactate, platelet count and coagulation function in patients with traumatic hemorrhagic shock, to provide reference for screening relatively ideal resuscitation fluid.
MethodsIn a prospective controlled study, 48 inpatients with traumatic hemorrhagic shock were selected and divided into observation group and control group using random number table method (24 cases in each group).Sodium bicarbonate Ringer's solution was used for resuscitation in the observation group, sodium lactate Ringer's solution was used in the control group, and limited fluid resuscitation strategy was used in both groups.The levels of interleukin (IL)-4, IL-6, IL-10, tumor necrosis factor (TNF)-α in peripheral blood and arterial blood lactate value, peripheral platelet count, plasma prothrombin time and fibrinogen level were measured before resuscitation and 1 hour after resuscitation.
ResultsOne hour after resuscitation, except TNF-α, the other factors in observation group were significantly higher than those before resuscitation (P < 0.01), while only IL-6 and IL-10 in control group were significantly higher than those before resuscitation (P < 0.01);the levels of IL-4 and IL-10 in peripheral blood in observation group were higher than those in control group, while the levels of IL-6 and TNF-α in observation group were lower than those in control group (P < 0.05);the level of arterial blood lactate in observation group was significantly lower than that in control group (P < 0.01), but there was no significant difference in platelet count, plasma prothrombin time and fibrinogen level(P>0.05).
ConclusionsEarly resuscitation with sodium bicarbonate Ringer's solution in patients with traumatic hemorrhagic shock can better inhibit the expression of inflammatory factors in peripheral blood and reduce the blood lactate value, which is better than sodium lactate Ringer's solution for resuscitation.

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