CAJ | 학술논문

目的研究创伤救治复苏的评价指标及影响因素,探讨创伤患者早期液体复苏的终极标准与监控效应.方法选择符合本项研究条件且需接受液体复苏者149例,采用损伤严重度评分(ISS)和急性生理学及慢性健康状况评分(APACHE Ⅱ)对其组织损伤程度和伤后病情危害状况进行评价与分组,收集液体复苏前、复苏后及结束等不同时间段的心率、血压、血氧饱和度、血气、血乳酸及中心静脉血氧饱和度或混合静脉血氧饱和度等,并记录每小时尿量,对应时间段的碱缺失及氧合指数等,分别比较监控指标的组间差异、时间效应及并发症或与预后的关系等.结果救治24 h实现终极标准的全身指标有127例,细胞指标有112例,两者平均恢复时间比较差异有统计学意义(P<0.05);各监测指标24 h均实现终点目标者与>24 h或死亡者的APACHEⅡ分值比较差异具有统计学意义(P<0.01);并发症或死亡组实现终极目标的时间明显高于对照存活组,组间差异均有统计学意义(P<0.05或P<0.01).结论创伤患者早期液体复苏不仅在于恢复生命体征的稳定,更重要是在血流动力学恢复正常的基础上,及时纠正组织灌流和细胞氧合不足,作为创伤救治复苏的终点目标.
목적 연구창상구치복소적평개지표급영향인소,탐토창상환자조기액체복소적종겁표준여감공효응.방법 선택부합본항연구조건차수접수액체복소자149례,채용손상엄중도평분(ISS)화급성생이학급만성건강상황평분(APACHE Ⅱ)대기조직손상정도화상후병정위해상황진행평개여분조,수집액체복소전、복소후급결속등불동시간단적심솔、혈압、혈양포화도、혈기、혈유산급중심정맥혈양포화도혹혼합정맥혈양포화도등,병기록매소시뇨량,대응시간단적감결실급양합지수등,분별비교감공지표적조간차이、시간효응급병발증혹여예후적관계등.결과 구치24 h실현종겁표준적전신지표유127례,세포지표유112례,량자평균회복시간비교차이유통계학의의(P<0.05);각감측지표24 h균실현종점목표자여>24 h혹사망자적APACHEⅡ분치비교차이구유통계학의의(P<0.01);병발증혹사망조실현종겁목표적시간명현고우대조존활조,조간차이균유통계학의의(P<0.05혹P<0.01).결론 창상환자조기액체복소불부재우회복생명체정적은정,경중요시재혈류동역학회복정상적기출상,급시규정조직관류화세포양합불족,작위창상구치복소적종점목표.
Objective To evaluate the physiological variables,which precisely and reliably reflected the effect of emergency fluid therapy for severely traumatized patients, in order to set up the ultimate criteria of optimal goal in fluid resuscitation. Method A total of 149 patients with severe trauma were given fluid resuscitation and were stratified into 3 groups with different severities of trauma as per ISS (injury severity score) and APACHE Ⅱ . Of all patients, heart rate (HR), systolic blood pressure (SBP), oxygen saturation of arterial blood (SaO2), blood gas analysis, arterial blood lactate (ABL), oxygen saturation of central venous blood (SCVO2) or oxygen saturation of mixed venous blood (SVC2), urine output, base excess (BE) and oxygenation index (OI = PaO2/FiO2) were measured and calculated. These variables were compared between groups to find out the significant differences and the relationship to response time to fluid therapy as well as complications and outcomes. Results Within 24 hours of fluid resuscitation, 127 patients reached the therapeutic goal in respect of systemic hemodynamics improved including the variables of SBP, HR and urine output, and the optimal goal of fluid therapy in 112 patients was estimated with cellular oxygen available found in the levels of ABL, BE and OI measured. These two sets of criteria (clinical signs vs laboratory findings) for determining the therapeutic goal showed significant difference in length of time taken for reaching the goal of treatment ( P < 0.05). There were significant differences in APACHE Ⅱ scores between those reaching the therapeutic goal within 24 hours and those taking longer time over 24 hours reaching the therapeutic goal or the death (P < 0.01). The duration of persistence in abnormal systemic hemody-namics and laboratory findings was longer in patients with complications or injured to death than that in survivors (P <0.05 -0.01). Conclusions In addition to the stability of vital signs, tissue perfusion and cellular oxy-genation should be taken as ultimate criteria of successful fluid resuscitation for severely traumatized patients judged by means of measuring the ABL, BE and OI variables.