CAJ | 학술논문

目的：探讨使用不同复苏液对失血性休克复苏患者血浆TNF-α、IL-2的影响，以期为失血性休克患者采用液体复苏的方式提供依据。方法选择2010年4月-2012年8月失血性休克患者40例为研究对象，随机分为观察组和对照组各20例，观察组在出血未控制前行限制性液体复苏，对照组在出血未控制前行常规液体复苏，观察两组患者血浆TNF-α、IL-2水平的变化以及复苏期间的液体入量。结果观察组患者日平均复苏液体输入量为（1946±349）mL，明显低于对照组的（3522±540）mL，差异具有显著性意义（P＜0．05）；两组患者的血浆TNF-α水平在复苏后60 min均高于复苏前的水平，差异具有显著性意义（P＜0．05），观察组患者的血浆TNF-α水平在复苏后60 min的水平均低于对照组，差异具有显著性意义（P＜0．05）；两组患者的血浆IL-2水平均在复苏后60 min高于正常值和复苏前的水平，差异具有显著性意义（P＜0．05），观察组患者的血浆IL-2水平在复苏后60 min的水平均低于对照组，差异具有显著性意义（ P＜0．05）。结论限制性液体复苏可显著降低失血性休克患者的出血量，稳定血流动力学，保证心、脑、肾等重要脏器的血流灌注，减轻血液的过度稀释与酸中毒，降低血浆的TNF-α和IL-2水平，改善预后。
목적：탐토사용불동복소액대실혈성휴극복소환자혈장TNF-α、IL-2적영향，이기위실혈성휴극환자채용액체복소적방식제공의거。방법선택2010년4월-2012년8월실혈성휴극환자40례위연구대상，수궤분위관찰조화대조조각20례，관찰조재출혈미공제전행한제성액체복소，대조조재출혈미공제전행상규액체복소，관찰량조환자혈장TNF-α、IL-2수평적변화이급복소기간적액체입량。결과관찰조환자일평균복소액체수입량위（1946±349）mL，명현저우대조조적（3522±540）mL，차이구유현저성의의（P＜0．05）；량조환자적혈장TNF-α수평재복소후60 min균고우복소전적수평，차이구유현저성의의（P＜0．05），관찰조환자적혈장TNF-α수평재복소후60 min적수평균저우대조조，차이구유현저성의의（P＜0．05）；량조환자적혈장IL-2수평균재복소후60 min고우정상치화복소전적수평，차이구유현저성의의（P＜0．05），관찰조환자적혈장IL-2수평재복소후60 min적수평균저우대조조，차이구유현저성의의（ P＜0．05）。결론한제성액체복소가현저강저실혈성휴극환자적출혈량，은정혈류동역학，보증심、뇌、신등중요장기적혈류관주，감경혈액적과도희석여산중독，강저혈장적TNF-α화IL-2수평，개선예후。
Objective To study the use of different recovery fluid in patients with uncontrolled hemorrhagic shock resusci -tation fluid plasma TNF-α, the influence of IL-2, so as to provide basis for uncontrolled hemorrhagic shock were treated by liquid recovery way .Methods Forty patients with uncontrolled hemorrhagic shock were selected between April 2010 to August 2010 , they were randomly divided into observation group and control group , observation group using restrictive liquidrecovery,and control group using conventional liquid recovery before bleeding control , serum TNF-α, IL-2 levels of change and recovery liquid intake during recovery in two groups were observed .Results The average recovery liquid of patients in observation group was (1 946 ±349) mL input variables significantly lower than control group ,(3 522 ±540) mL, with statistical difference (P<0.05).Two groups patients serum TNF -αlevel 60 min after the recovery are higher than before the recovery level , with statistical difference (P<0.05), the observation group of patients with serum TNF -αlevel 60 min after recovery level were significantly lower than the control group , with statistical difference (P<0.05).The patient's level of serum IL-2 of two group were higher than normal amount of 60 min after the recovery and the level before recovery, with statistical difference (P<0.05), the observation group of patients with serum level of IL -2in the 60 min after recovery levels were significantly lower than the control group , with statistical difference (P<0.05).Conclu-sion limited fluid resuscitation can significantly reduce uncontrolled hemorrhagic shock in patients with blood loss , stable flow mechanics, guarantee the important organs such as heart , brain, kidney blood perfusion , reduce the excessive blood dilution and acidosis, reduce serum TNF-αand IL -2 levels, improve the prognosis.