3%和7.5%高渗盐水治疗创伤失血性休克的临床研究【摘要】目的探讨单剂质量分数为3%和7.5%的高渗盐水在创伤失血性休克急救早期液体复苏中的应用。方法2008年12月至2012年2月，将年龄＞15岁,收缩压W70mmHg或介于70〜90mmHg(1mmHg=0.133kPa)而心率＞108次/min的严重创伤患者，随机(随机数字法)分为三组进行液体复苏，A组：3%高渗盐水300mL+林格式液；B组：7.5%高渗盐水300n)L+林格液；C组：林格液。观察其输液前及之后10、30、45、60min时平均动脉压(MAP)、血压、心率、电解质变化，不良反应以及后期MODS、病死率情况。结果148例患者入选本项研究。A、B组的升压效果明显优于C组。B组MAP在用药后30min达到峰值(76.22±3.12)mmHg,高于A组，但其他时间点与A组无异无统计学意义。1h所用液体总量A、B组仅为C组的50%。B组心率的变化幅度明显高于其余两组，尤其在10min时相点，平均达到127次/min,出现严重心慌不适的患者比例高于其他两组，少部分患者还出现一过性的血压下降。而A、C两组间心率变化差异无统计学意义。三组用药前后电解质改变均不明显，三组比较MODS及病死率差异均无统计学意义。结论在创伤性失血性休克患者的救治早期，单剂300mL3%和7.5%高渗盐水都有助于提高和维持血压。两种质量分数的高渗盐水升压效果近似，3%高渗盐水的耐受性和安全性更好。【关键词】3%高渗盐水；7.5%高渗盐水；失血性休克；急救；复苏；创伤；血流动力学Hypovolemiashockresuscitatedwith3%and7.5%hypertonicsalineinemergencydepartmentQiaoZhuoyi,HanJuan，WangXingzhi,LiuJian,ZhaoQingbo,LiuWanbao.EmergencyDepartment,PLA324Hospital,Chongqing400020,ChinaCorrespondingauther：QiaoZhuoyi,Email：jzk324@163.com[Abstract]ObjectiveToinvestigatetheeffectsof3%and7.5%hypertonicsaline(HS)onhemorrhagicshockpatientsinEmergencyDepartment.MethodsFromDecember2008toFebruary2012,pationtsolderthan15yearswithseveretraumaandsystoliebloodpressure(SBP)W70mmHgor70to90mmHgwithheartrate2108perminuteweredividedintothreegroupsrandomly(randomnumber).GroupA：patientstreatedwith3%hypertonicsaline(HS)300mL+lactatedRinger?ssolutions(LRS).GroupB：patientstreatedwith7.5%HS300mL+LRS.GroupC：patientstreatedwithLRS.Themeanarterialpressure(MAP),bloodpressure(BP),heartrate(HR)wererecordedbeforeinfusionandat10,30,45,60minutessuccessivelyafterinfusion.Incidenceofcomplicationsandmortalityrateswerecomparedbetweengroups・ResultsAtotalof148patientswereenrolledinthisstudy.ComparedwithLRSgrouop,MAPwasrestoredmorepromptlyandmaintainedpersistentlyin3%HSgroupand7.5%IISgroup,andthetotalvolumeoffluidinfusedwasdecreasedtoalmost50%ofLRSinthefirst1hour.NosignificantdifferencesinMAPlevelswereobservedbetweengroupAandBexcept30minutesafterinfusion.Singlebolusof7.5%HSinfusionresultedinincreasedofHRtomean127beatsperminuteat10minutesafterfluidresuscitation.Higherincidenceofarrhythmiaandtransienthypotensionoccurredin7.5%HSgroup・Therewerenostatisticaldifferencesofchangesofelectrolyticindices,mortalityrates,incidencesofARDSandMODSamongthreegroups.ConclusionsResuscitationwith3%HSprovidesimilarbonofitsandlowerriskofcomplicationscomparedwith7.5%HSandLRS.Thisstudydemonstratesthepracticabilityandsafetyof3%HSforfluidresuscitationofpatientswithhypovolemicshock•［Keywords}3%Hypertonicsaline；7.5%Hypertonicsaline；Hemorrhagicshock；Emergencytreatment；Resuscitation；Trauma；Haemodynamicparameters人吊补液会给失血性休克患者带来诸多并发症，如ARDS、酸中毒、凝血障碍、低体温、腹膜间隙综合征、颅压增高、肺水肿等。理想的液体复苏应该在维持灌注的同时尽量减少上述并发症的发生。大量动物实验及临床研究表明，小剂量高渗盐水(hypertonicsaline,HS)可以快速扩容升压；增强心输出量；降低颅内压增加脑灌注...