高原藏、汉族创伤失血性休克患者对液体耐受能力的差异及对策
失血性休克；,,液体复苏；高原,临床资料,1一般资料,2方法,结果,讨论,参考文献：
摘要： 目的 探讨高原地区(海拔3 658m)藏、汉族创伤失血性休克患者休克早期对复苏液体耐受能力的差异及对策。方法 通过对332例高原世居藏族(A组)、216例高原移居汉族(移居高原3个月以上,B组)和18例急进高原汉族(进入高原1周以内,C组)中度创伤失血性休克的有关资料进行回顾性比较、分析研究，找出他们的早期液体复苏的特点及规律。结果 C组患者早期可耐受晶体液为失血量的1～1.5倍，维持血压所需的胶体液用量约为失血量的1~1.5倍(晶胶比约为1:1), 总量不超过总失血量的2.5倍，输液速度以0.5～1.0ml/(kgB.W.·min)为宜；B组患者可耐受的晶体液为失血量的1.5～2倍,维持血压的胶体液用量约为失血量的0.75~1倍(晶胶比约为2:1),总量不超过3倍，输液速度先快[1～1.5ml/(kgB.W.·min)]后慢;A组患者晶体液可达3～4倍以上,早期可不输或输0.5倍失血量的胶体液(晶胶比约为4:1), 耐受快速输液1.5～2.0ml/(kgB.W.·min)。结论 C组患者液体耐受能力显著低于B组患者，B组又显著低于A组。提高晶胶液体比例、放慢输液速度、延长持续复苏时间、保护肺脑组织细胞、应用高渗液体等措施可增加失血性休克的早期液体输入量。关键词：液体复苏；高原
Different tolerance to fluid resuscitation of traumatic hemorrhagic shock in Tibetan and the Han nationality and its strategy of treatment
YIN Zuoming, LI Suzhi, LIN Xiulai,et al.
(Department of Orthopaedics,General Hospital of The Tibetan Military Command,Lasha 850003,China)
Abstract: Objective To explore the different tolerance to early fluid resuscitation of traumatic hemorrhagic shock cases of Tibetan and the Han nationality and the strategy of treatment.Methods By analyzing the amount of fluid infusion and the difference of the 332 cases of Tibetan habitant (group A),216 cases of migrant Hans (migrating to high altitude more than 3 months(group B) and 18 cases of the Hans just entering into high altitude within one week(group C) of moderate traumatic hemorrhagic shock to know the characteristics and the principle of early fluid resuscitation among them.Results The patients of group C could endure 11.5 volumes of the total losts of blood at the early time,and required 11.5 volumes of colloids to maintain the hemodynamics(the ratio of crystalloid to colloid was 1:1), the amount of total infusion was not more than 2.5 times,the proper infusion rate was 1.0 ml/kg body weight /min.The patients of group B could endure 1.52.0 volumes of crystalloid at early time,and required 0.751 volume of colloids to maintain the hemodynamics(the ratio of crystalloid to colloid was 2:1),the total infusion was not more than 3 times of the total lost blood ,the infusion rate was fast at first (1.01.5 ml/kg body weight /min) and then slowed down.The patients of group A could endure 34 volumes of the total loss of blood,and did not need colloid or may infuse 0.5 volume of colloid(the ratio crystalloid and colloid was 4:1),could endure fast infusion rate(1.52.0 ml/kg body weight /min ).Conclusion The fluid tolerance of group C was significantly lower than that of group B,and that of group B was significantly lower than that of group A.Increasing the crystalloid and colloid ratio,slowing down the fluid infusion rate,prolonging the fluid resuscitation duration,using hypertonic solution,etc,may increase the early fluid infusion amount in the patients of traumatic hemorrhagic shock. ......
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