刘凡孝,周东生,崔昊旻,许维澄,贺宇,赵之孟

• 1:山东大学附属省立医院创伤骨科

摘要(Abstract)：

骨盆骨折是创伤骨科中比较复杂的骨折类型,多由高能量损伤造成。严重骨盆骨折患者入院时多数已伴有严重的失血性休克,是骨盆骨折早期死亡的主要原因。液体复苏是骨盆骨折急救早期面临的首要问题,急救早期的液体复苏是维持患者生命的关键措施,其目的是尽快恢复有效血容量,维持组织器官的血液灌注,防止组织细胞缺血、缺氧。近年来,液体复苏有限制性液体复苏与传统积极液体复苏之争,如何正确的进行早期液体复苏对骨盆骨折患者的生存率、预后及并发症发生率起着重要作用,本文将从液体复苏的分类,复苏时血压控制的水平和时间窗以及疗效等方面,探讨液体复苏在骨盆骨折急救中的应用进展,旨在为骨盆骨折早期液体复苏急救提供新的认识。

关键词(KeyWords)： 骨盆骨折;积极液体复苏;限制性液体复苏;急救

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 刘凡孝,周东生,崔昊旻,许维澄,贺宇,赵之孟

参考文献(References)：

• [1]胥少汀,葛宝丰,徐印坎.实用骨科学[M].3版.北京:人民军医出版社,2009:658.
• [2]Katsoulis E,Giannoudis PV.Impact of timing of pelvic fixation on functional outcome[J].Injury,2006,37:1133-1142.
• [3]赵资坚,邹育才,刘梦璋,等.骨盆骨折院前急救和院内救治的损伤控制策略应用体会[J].中国矫形外科杂志,2013,21:2019-2024.
• [4]Takasu A,Minagawa Y,Ando S,et al.Improved survival time with combined early blood transfusion and fluid administration in uncontrolled hemorrhagic shock in rats[J].J Trauma,2010,68:312-316.
• [5]赵小纲.严重创伤救治若干新进展[J].创伤外科杂志,2013:190-192.
• [6]郝振海,周东生,李少华,等.自体输血在骨盆骨折术中的应用[J].山东医药,2007:109-110.
• [7]周东生,董金磊,王伯珉,等.伴直肠肛管损伤的开放性骨盆骨折的早期急救处理策略及死亡危险因素分析[J].中华骨科杂志,2010,30:1121-1126.
• [8]Taguchi K,Ogaki S,Watanabe H,et al.Fluid resuscitation with hemoglobin vesicles prevents escherichia coli growth via complement activation in a hemorrhagic shock rat model[J].J Pharmacol Exp Ther,2011,337:201-208.
• [9]Saito Y,Suzuki Y,Yamanashi Y,et al.The impact on renal function of fluid resuscitation with hemoglobin vesicle solution in moderate hemorrhagic shock[J].J Artif Organs,2013,16:376-381.
• [10]Yamamoto M,Horinouchi H,Kobayashi K,et al.Fluid resuscitation of hemorrhagic shock with hemoglobin vesicles in Beagle dogs:pilot study[J].Artif Cells Blood Substit Immobil Biotechnol,2012,40:179-195.
• [11]Hubetamann B,Lefering R,Taeger G,et al.Influence of prehospital fluid resuscitation on patients with multiple injuries in hemorrhagic shock in patients from the DGU trauma registry[J].J Emerg Trauma Shock,2011,4:465-471.
• [12]Stern SA,Dronen SC,Wang X.Multiple resuscitation regimens in a near-fatal porcine aortic injury hemorrhage model[J].Acad Emerg Med,1995,2:89-97.
• [13]Qin W,Yu YH,Wang CH.Effect of hypotensive fluid resuscitation on microcirculation in an uncontrolled hemorrhagic shock of pregnant rabbits[J].Zhonghua Fu Chan Ke Za Zhi,2010,45:775-780.
• [14]Li T,Zhu Y,Hu Y,et al.Ideal permissive hypotension to resuscitate uncontrolled hemorrhagic shock and the tolerance time in rats[J].Anesthesiology,2011,114:111-119.
• [15]赵红亮,牛东升,范丰兵,等.限制性液体复苏与积极液体复苏救治多发伤的效果比较[J].中外医学研究,2013:16-17.
• [16]Rossaint R,Bouillon B,Cerny V,et al.Management of bleeding following major trauma:an updated European guideline[J].Crit Care,2010,14:52.
• [17]中华医学会重症医学分会.低血容量休克复苏指南(2007)[J].中国实用外科杂志,2007,8:581-587.
• [18]范海鹏,岳茂兴,吴耀建,等.限制性液体复苏在严重骨盆骨折并失血性休克急诊早期的疗效观察[J].创伤外科杂志,2011,13:419-421.
• [19]何余庆,杨海波.控制性液体复苏对严重骨盆骨折患者血清细胞因子的影响[J].中国现代医生,2011:48-49.
• [20]吴燕生,李金雨,李昌.限制性液体复苏在急诊抢救骨盆骨折并失血性休克的临床观察[J].临床军医杂志,2012,40:614-615.