Effects of different fluid resuscitation strategies on coagulation function, immune regulation and therapeutic effect in patients with traumatic shock and TIC#br#
YAN Xiao-wei， LI Xiao-dong， LI Su-qing， HUA Li-wei*， DUAN Li-juan， ZHAO Jin-yuan
2019, 40(11):
1279-1284.
doi:10.3969/j.issn.1007-3205.2019.11.009
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［Abstract］ Objective〖HTSS〗To investigate the effects of active fluid resuscitation（AFR）and damage control resuscitation（DCR） on coagulation function, immune regulation, and therapeutic efficacy in patients with traumatic shock and trauma induced coagulopathy(TIC).
〖HTH〗〖WTHZ〗Methods〖HTSS〗The clinical data of 94 patients with traumatic shock and TIC treated were retrospectively analyzed. According to the fluid resuscitation strategy, the patients were divided into the amage control resuscitation group(DCR group, 48 cases) and active fluid resuscitation group(AFR group, 46 cases) . The international normalized ratio （INR）, prothrombin time(PT), activated partial prothrombin time(APTT), D-dimer in two groups at 20 min before resuscitation and 12 h after resuscitation, and the two groups of shock index（SI），mean arterial pressure(MAP), blood pressure fluctuation amplitude, total fluid volume at 18 h after resuscitation, Phospholipase A2(PLA2), platelet activating factor(PAF) at 20 min before resuscitation, 12 h, 24 h, and 48 h after resuscitation, within 96 h of recovery the complication rate and the survival rate at 1 week after resuscitation were compared.
〖HTH〗〖WTHZ〗Results〖HTSS〗There was no significant difference in MAP, SI, and Injury Severity Score(ISS) between two groups at admission(P＞0.05). There was no significant difference in the INR, APTT, PT, and D-dimer values between the two groups at 20 min before resuscitation(P＞0.05). INR, APTT, PT, and D-dimer values were significantly lower in the DCR group than those in the AFR group at 12 h after resuscitation(P<0.05). The MAP, blood pressure fluctuation amplitude, SI value, and total rehydration dose in the DCR group were significantly lower than those in the AFR group at 18 h after resuscitation(P<0.05). There was no significant difference in PLA2 and PAF between two groups at 20 min before and 24 h after resuscitation(P＞0.05). The PLA2 and PAF at 12 h after resuscitation in the DCR group were significantly higher than those in the AFR group(P<0.05). The PLA2 and PAF at 48 h after resuscitation were in the DCR group were significantly lower than those in the AFR group(P<0.05). After 96 h of resuscitation, the complication rate in the DCR group was significantly lower than in the AFR group, and the survival rate after one week of resuscitation in the DCR group was significantly higher than in the AFR group(P<0.05).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗DCR treatment of traumatic shock with TIC patients, significantly improved coagulation parameters, effective correction of shock, stable blood pressure during resuscitation, low incidence of complications, high survival rate, clinical efficacy compared with AFR significantly, but AFR can be early in resuscitation treatment effective inhibition of immune cytokines, inflammatory mediators, has a certain degree of immune regulation.
