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目的探讨感染性休克患者输血治疗的有效性,为感染性休克的治疗提供参考依据。方法选取2010年1月-2015年6月住院治疗的感染性休克患者60例,随机分为输血组与未输血组各30例,给予治疗原发病、纠正酸中毒及电解质紊乱、抗感染、利尿、强心等基础治疗,输血组同时输注全血200~400ml;记录患者复苏24h时液体总量、每小时尿量、中心静脉压(CVP)、平均动脉压(MAP)、心输出量(CO)、全心舒张末期容积指数(GEDVI),复苏前及复苏3d时患者血清降钙素原(PCT)、C-反应蛋白(CRP)水平变化,肺水肿发生率及28d内病死率。结果两组复苏24h时每小时尿量、CVP、MAP、GEDVI均较复苏前明显改善(P<0.05),输血组复苏24h时液体总量少于未输血组(P<0.05),每小时尿量多于未输血组(66.08±54.83)ml(P<0.05);两组复苏3d时血清PCT、CRP均较复苏前明显下降(P<0.05),输血组复苏3d时血清PCT、CRP低于未输血组;输血组与未输血组肺水肿发生率分别为6.67%、13.33%,比较差异无统计学意义,28d内病死率输血组为0,未输血组为16.67%,差异均有统计学意义(P<0.05)。结论感染性休克患者在常规液体复苏基础上适当进行输血治疗,可减少输液总量,增强机体抗炎症反应能力,有利于降低病死率。
Objective To investigate the effectiveness of transfusion in patients with septic shock and provide a reference for the treatment of septic shock. Methods Sixty patients with septic shock admitted to hospital from January 2010 to June 2015 were randomly divided into transfusion group and non-transfusion group, 30 cases each. The patients were treated with primary disease, acidosis and electrolyte disturbance, anti-infection, Diuretic, cardiac and other basic treatment, transfusion group also infusion of whole blood 200 ~ 400ml; record 24h recovery of patients liquid volume, hourly urine output, central venous pressure (CVP), mean arterial pressure (MAP), cardiac output (CO), global end-diastolic volume index (GEDVI), serum procalcitonin (PCT) and C-reactive protein (CRP) levels, pulmonary edema and mortality within 28 days before and during resuscitation. Results The hourly urine output, CVP, MAP and GEDVI were significantly improved (P <0.05) before resuscitation in 24h and 24 h after resuscitation, respectively. Total volume of fluid in 24h after resuscitation was lower than that in non-transfusion group (P <0.05) The levels of PCT and CRP in resuscitation were significantly lower than those before resuscitation in both groups (P <0.05). The levels of serum PCT and CRP in resuscitation of transfusion group were lower than those in the non-transfused group (66.08 ± 54.83) ml The incidences of pulmonary edema in transfused group and non-transfused group were 6.67% and 13.33%, respectively. There was no significant difference between the two groups (P> 0.05). The mortality rate within 28 days was 0 in the blood transfusion group and 16.67% in the non-transfused group, with statistical differences Significance (P <0.05). Conclusion In septic shock patients, blood transfusion can be appropriately performed on the basis of conventional liquid resuscitation, which can reduce the total amount of infusion and enhance the anti-inflammatory response ability of the body, which is beneficial to reduce the mortality.