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林萍清1,闵军1▲,林成实1,刁良彪2,林金贵1.床旁血气分析结合即时超声对急诊创伤失血性休克抢救的应用研究[J].中国医药科学,2024,14(11):177-180        基金项目:福建省创伤骨科急救与康复临床医学研究中心(2020Y2014)
床旁血气分析结合即时超声对急诊创伤失血性休克抢救的应用研究
Research on the application of bedside blood gas analysis combined with real-time ultrasound in emergency rescue of traumatic hemorrhagic shock
  
DOI:
中文关键词:  急诊创伤失血性休克;床旁血气分析;床旁即时超声;凝血功能
英文关键词:Energency traumatic hemorrhagic shock; Bedside blood gas analysis; Bedside real-time ultrasound; Coagulation function
作者单位
林萍清1,闵军1▲,林成实1,刁良彪2,林金贵1 1.福州市第二总医院急诊科,福建福州 350007;2.福州市第二总医院肾内科,福建福州 350007 
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中文摘要:
      [摘要] 目的 探讨床旁血气分析结合即时超声对急诊创伤失血性休克的应用效果。方法 选取2022年1月至2023年4月于福州市第二总医院急诊创伤失血性休克患者100例,随机分为对照组(50例,常规对症治疗+常规液体复苏治疗)与观察组(50例,对照组基础上采用床旁血气分析结合床旁即时超声进行液体复苏治疗)。比较两组复苏状态[平均动脉压(MAP)、每小时尿量、心率(HR)]、血气指标[脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、血乳酸(BL)、剩余碱(BE)及血酸碱度(pH)]、凝血指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)]变化,比较两组复苏24 h补液量及液体复苏治疗1周生存率。 结果 两组复苏前复苏状态、血气、凝血等指标比较,差异无统计学意义(P > 0.05);复苏24 h,观察组HR、PaCO2、BL、BE、PT、APTT、TT低于对照组,观察组MAP、每小时尿量、pH、PaO2高于对照组,观察组复苏24 h补液量少于对照组,观察组1周生存率高于对照组,差异均有统计学意义(P < 0.05)。 结论 床旁血气分析结合即时超声应用于急诊创伤失血性休克,有利于患者状态恢复,能够改善血气指标、凝血功能,提高整体疗效。
英文摘要:
      [Abstract] Objective To investigate the application effect of bedside blood gas analysis combined with real-time ultrasound in emergency traumatic hemorrhagic shock. Methods A total of 100 patients with traumatic hemorrhagic shock in the Department of Emergency of Fuzhou Second General Hospital from January 2022 to April 2023 were selected and divided into the control group (n=50) and the observation group (n=50) according to the random number table method. Both groups were treated with conventional symptomatic therapy, while the control group was treated with conventional fluid resuscitation. The observation group was treated with bedside blood gas analysis combined with bedside real-time ultrasound for fluid resuscitation on the basis of the control group. The resuscitation status changes (mean arterial pressure [MAP], urine output per hour, heart rate [HR]), blood gas indices (partial pressure of arterial oxygen [PaO2], partial pressure of arterial carbon dioxide [PaCO2], blood lactic acid [BL], base excess [BE] and blood pH [pH]), coagulation indices (prothrombin time [PT], activated partial thromboplastin time [APTT], and thrombin time [TT]) between two groups were compared. The 24-hour fluid resuscitation volume and the 1-week survival rate of fluid resuscitation treatment between the two groups were compared. Results There was no significant difference in the resuscitation status, blood gas and coagulation between the two groups before resuscitation (P > 0.05). Compared with the control group, the HR, PaCO2, BL, BE, PT, APTT and TT in the observation group were lower, while MAP, urine volume,pH and PaO2 were higher. The volume of fluid infusion within 24 hours of resuscitation in the observation group was less than that in the control group, and the 1-week survival rate in the observation group was higher than that in the control group (P < 0.05). Conclusion Bedside blood gas analysis combined with real-time ultrasound in emergency traumatic hemorrhagic shock is beneficial to the resuscitation of patients’ status, and can improve blood gas indices, coagulation function and overall therapeutic efficacy.
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