高渗氯化钠复合琥珀酰明胶治疗失血性休克的临床观察
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[摘要] 目的：观察高渗氯化钠复合琥珀酰明胶治疗失血性休克的临床效果。方法：选择本院住院的失血性休克患者60例，将其随机分为高渗氯化钠液组(HSC组)(n=30)和高渗氯化钠复合琥珀酰明胶组(HSCG组)(n=30)，观察患者休克复苏的效果，并记录患者复苏前后血流动力学的变化。结果：两组治疗前后比较休克症状均有改善，MAP、CVP、PCWP上升，尿量增加，血乳酸下降；HSCG组经治疗后MAP、CVP、PCWP上升幅度及尿量明显高于HSC组(P<0.01)，且作用维持时间长，血乳酸下降更加明显。结论：高渗氯化钠复合琥珀酰明胶在复苏急性失血性休克的患者中效果优于高渗氯化钠。
[关键词] 失血性休克；复苏；高渗氯化钠；琥珀酰明胶
[中图分类号] R459.7 [文献标识码]B[文章编号]1674-4721(2011)07(c)-098-02
The clinical observation of hypertonic sodium chloride compound succinylated gelatin in curing hemorrhagic shock
LONG Xiong, ZHENG Tianyong, GUO Yufeng, HE Bingquan, WU Jingbo
The Affiliated Xiao Lan Hosipital of Southern Medical University, Guangdong Province, Zhongshan 528415, China
[Abstract] Objective: To observe the clinical effects of the treatment of hypertonic sodium chloride compound succinylated gelatin in hemorrhagic shock. Methods: 60 cases of hemorrhagic shock patients who were picked up by emergency department were randomly divided into hypertonic sodium chloride (HSC) group (n=30) and hypertonic sodium chloride compound succinylated gelatin (HSCG) group (n=30). Observed the effects of resuscitation and recorded the hemodynamic changes before and after the treatment for the patients. Results: Shock symptoms in both groups were relieved. MAP, CVP, PCWP and urine were increased while lactate was decreased. These changes in the HSCG group were more significant. Conclusion: The hypertonic saline solution associating with gelofusion has better effect in the recovery for the hemorrhagic shock patients than hypertonic sodium chloride solution.
[Key words] Hemorrhagic shock; recovery; Hbypertonic sodium chloride; Succinylated gelati
失血性休克是临床常见的急症之一，是由于机体短时间内失血超过机体全身总血量的20%时出现的有效循环血容量减少、组织灌注不足，细胞代谢紊乱和功能受损的病理过程。补充血容量、提高携氧能力和增加组织灌注量、恢复心排量能为后续的治疗赢取时间，增加抢救的成功率。因此，补液为失血性休克的关键复苏手段。近年来推荐的小容量复苏(用7.5%氯化钠溶液4 ml/kg进行复苏)，由于对全身器官及微循环水平的多种作用，在失血性休克的早期复苏中其运用已达共识。但由于它维持循环稳定的时间短(约2 h)且有导致高钠血症的危险，一定程度上限制了其应用。加入胶体液(通常为右旋糖酐70)后，不仅作用时间延长，效果亦加强[1]。然而右旋糖酐有凝血障碍、干扰血型鉴定、抑制网状内皮系统和变态反应等不容忽视的副作用，临床应用受到一定的限制。本实验研究高渗氯化钠复合琥珀酰明胶对失血性休克的治疗效果，以寻找更好的休克复苏的补液方案。
1 资料与方法
1.1 一般资料
选择2010年1月～2011年1月在本院住院的60例患者，男38例，女22例，年龄18~62岁，平均(36.6±4.8)岁，体重40~55 kg ......
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