Application of cryoprecipitated coagulation factor combined with restrictive fluid resuscitation in the treatment of traumatic hemorrhagic shock
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摘要: 目的:探讨在创伤性失血性休克患者紧急救治中冷沉淀凝血因子配合限制性液体复苏(LFR)的应用效果。方法:对92例创伤性失血性休克患者紧急救治的临床资料进行回顾,均接受常规急救,其中有42例实施LFR治疗,记为A组;余50例实施冷沉淀凝血因子配合LFR治疗,记为B组。将救治成功率,液体复苏指标,治疗前后凝血功能和血小板计数(PLT)变化,并发症发生率作为观察指标评价不同方法的疗效。结果:B组救治成功率高于A组(P<0.05);2组开始复苏时间相近(P>0.05),B组开始手术时间短于A组(P<0.05),总输液量少于A组(P<0.05);治疗后2组凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)均缩短(P<0.05),且B组均短于A组(P<0.05);治疗后2组纤维蛋白原(Fbg)均升高(P<0.05),且B组高于A组(P<0.05);2组治疗后PLT水平均升高(P<0.05),且治疗后2组间差异无统计学意义(P>0.05);B组并发症发生率与A组接近(P>0.05)。结论:对创伤性失血性休克采用冷沉淀凝血因子配合LFR实施救治可提高救治成功率,改善液体复苏效果,减少总输液量,还可促进凝血,控制并发症。Abstract: Objective: To explore the effect of cryoprecipitated coagulation factor and limited fluid resuscitation(LFR) in emergency treatment of traumatic hemorrhagic shock patients. Method: The clinical data of 92 patients with traumatic hemorrhagic shock were retrospectively analyzed. All patients received routine first aid. Among them, 42 cases were treated with LFR, and the remaining 50 cases were treated with cryoprecipitated coagulation factor and LFR, which were recorded as group B. The success rates of treatment, the indexes of fluid resuscitation, the changes of coagulation function and platelet count(PLT) before and after treatment, and the incidences of complications were used as observation indexes to evaluate the efficacy of different methods. Result: The success rate of treatment in group B was higher than that in group A(P<0.05). The resuscitation time of group B was shorter than that of group A(P<0.05), and the total infusion volume was less than that of group A(P<0.05). Thrombin time(TT), prothrombin time(PT) and activated partial thrombin time(APTT) were shortened in both groups after treatment(P<0.05), and those in group B were shorter than those in group A(P<0.05). Fibrinogen(Fbg) increased in both groups after treatment(P<0.05), and in group B it was higher than that in group A(P<0.05). After treatment, the level of PLT in both groups increased(P<0.05), and there was no significant difference between the two groups(P<0.05). The incidence of complications in group B was close to that in group A(P>0.05).Conclusion: The treatment of traumatic hemorrhagic shock with cryoprecipitated coagulation factor combined with LFR can improve the success rate of treatment, improve the effect of fluid resuscitation, reduce the total infusion volume, promote coagulation and control complications.
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