Early recovery strategy based on base excess condition for patients with traumatic hemorrhagic shock
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摘要:目的 依据碱缺失(BE)情况探讨创伤性失血性休克早期液体复苏策略。方法 选取创伤性失血性休克患者60例，其中急诊术后无代谢性酸中毒6例, 48 h内未纠正代谢性酸中毒13例, 48 h内纠正代谢性酸中毒41例。将纠正代谢性酸中毒41例依据BE≤-6 mmol/L、BE>-6 mmol/L分为重度代谢性酸中毒组29例(A组)、轻度代谢性酸中毒组12例(B组)，回顾性分析2组创伤严重程度(ISS)评分、就诊时间、血小板计数、代谢性酸中毒实际纠正时间、输血占比、液体输入速率。结果 A组与B组在补液速率、BE方面比较有显著差异(P < 0.05)。结论 对于创伤性失血性休克患者，在损伤出血控制情况下，依据BE值快速选择补液速率可尽早纠正代谢性酸中毒，提高抢救成功率。Abstract:Objective To explore the early fluid resuscitation strategy based on base excess (BE) condition for patients with traumatic hemorrhagic shock.Methods Sixty patients with traumatic hemorrhagic shock were selected, including 6 cases without metabolic acidosis after emergency operation, 13 cases with metabolic acidosis without correction within 48 hours and 41 cases with metabolic acidosis within 48 hours. For 41 cases, they were divided into severe metabolic acidosis group (group A, n=29) and mild metabolic acidosis group (group B, n=12) according to BE≤ -6 mmol/L and BE>6 mmol/L. The severity of trauma (ISS) score, visiting time, platelet count, actual correction time of metabolic acidosis, proportion of blood transfusion and fluid input rate in both groups were retrospectively analyzed.Results There were significant differences in fluid replacement rate and BE between group A and group B (P < 0.05).Conclusion For patients with traumatic hemorrhagic shock, rapid selection of rehydration rate based on BE value can correct metabolic acidosis as soon as possible and improve the success rate of rescue under the condition of injury and hemorrhage control.
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表 1 A组与死亡组相关指标比较(x±s)
组别 ISS评分/分 就诊时间/h 输血比/% 血小板计数/(×109/L) 补液速率/(mL/h) BE/(mmol/L) A组 32.50±14.43 1.76±1.12 41.06±15.61 60.38±33.76* 565.00±201.50* -9.71±3.42* 死亡组 38.80±10.19 1.85±0.99 41.49±19.98 37.54±28.66 876.00±422.80 -16.07±5.43 BE: 碱缺失。与死亡组比较, *P < 0.05。 
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表 2 A组与B组相关指标比较(x±s)
组别 ISS评分/分 就诊时间/h 输血比/% 血小板计数/(×109/L) 补液速率/(mL/h) BE/(mmol/L) 代谢酸中毒实际纠正时间/h A组 32.50±14.43 1.76±1.12 41.06±15.61 60.38±33.76 565.00±201.50* -9.71±3.42* 27.59±10.70 B组 37.10±10.90 1.71±0.75 36.71±12.26 50.90±24.89 421.00±197.70 -4.48±0.78 27.61±7.64 BE: 碱缺失。与B组比较, *P < 0.05。
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