Abstract:Objective To study and analyze the application of multi-mode rewarming management in patients with traumatic hemorrhagic shock and its effect on patients with hypothermia and stress response. Methods One hundred and four patients with traumatic hemorrhagic shock admitted to our hospital from March 2019 to April 2020 were selected as the subjects of this study. All patients were divided into the control group and the intervention group according to random number table method, with 52 cases in each group. The patients in the control group received conventional rewarming management mode, and the patients in the intervention group received multimode rewarming management. The levels of hemodynamics and stress response indexes of the two groups of patients before and after intervention were compared, so were the incidences of complications such as average fluid volume, shock index, hypothermia after intervention. Results After the intervention, the average fluid volume (1 208.22±114.15) mL and shock index (0.78±0.26) of the patients in the intervention group were significantly lower than those in the control group [(4 218.27±274.29) mL, (1.84±0.42)] (P<0.001). The hemodynamic parameters PI, PSV, RI, and EDV levels of the two groups of patients increased after intervention, and the difference in the increase of each index of the intervention group was higher than that of the control group (P<0.001). After the intervention, the levels of serum stress response NE, ACTH, Cor, and GLU increased in the two groups, and the differences in the reduction of indicators in the intervention group were higher than those in the control group (P<0.001). The incidences of complications such as hypothermia, chills, restlessness, and hypoxemia in the intervention group were significantly lower than those in the control group (P<0.05). Conclusion The application of multimode rewarming management in patients with traumatic hemorrhagic shock has a definite effect, which can effectively relieve the shock status of patients with traumatic hemorrhagic shock, improve hemodynamics and stress response indicators, and reduce the amount of fluid replacement and hypothermia and chills risk of other complications.
金清河,颜雷雷,黄秀. 多模式复温管理对创伤失血性休克患者应用效果评价[J]. 中国医院统计, 2020, 27(6): 537-540.
Jin Qinghe, Yan Leilei, Huang Xiu. . Evaluation of the effect of multi-mode rewarming management on patients with traumatic hemorrhagic shock. journal1, 2020, 27(6): 537-540.
[1]陈东方,陈庆永,陈阳龙,等.限制性液体复苏联合体温管理在腹部严重创伤伴失血性休克患者中的应用效果[J].中华灾害救援医学,2020,8(1):52-54.
[2]李林,胡海姣,刁玉刚.损伤控制性复苏对低温失血性休克大鼠全脑缺血再灌注损伤保护作用[J].创伤与急危重病医学,2019,7(2):82-84.
[3]HISAEDA K, KOSHIISHI T, SASAKI A, et al. Changes in ionized calcium concentration in the blood of dairy cows with peracute coliform mastitis[J]. J Vet Med Sci, 2020, 82(4):457-462.
[4]安伟峰,丁楠楠,张玲.纠正亚低温联合限制性液体复苏在严重腹部创伤合并失血性休克的应用[J].医学临床研究,2019(4):783-785.
[5]贾炳学.纠正亚低温联合限制性液体复苏对严重腹部创伤失血性休克患者预后的影响[J].中国医药导刊,2019,21(3):143-147.
[6]中国医师协会急诊医师分会.创伤失血性休克诊治中国急诊专家共识[J].临床急诊杂志,2017,18(2):881-889.
[7]徐殊,王辉山,尹宗涛,等.肾素血管紧张素醛固酮系统在猪失血性休克后深低温救治与单纯低温应激过程中变化研究[J].临床军医杂志,2018,46(8):874-877.
[8]李雯,蒋娟,段晶晶,等.急诊创伤后发生自发性低体温的影响因素及其相关性[J].国际护理学杂志,2020,39(4):599-602.
[9]陈姿妃,林芝.苏醒期专项护理在预防全麻腹腔镜手术患者苏醒期躁动低体温及恢复期寒战的应用研究[J].中国药物与临床,2020,20(1):135-137.
[10]PRASHANTHA Y N, NESARGI S, CHANDRAKALA B S, et al. Therapeutic hypothermia for moderate and severe hypoxic ischaemic encephalopathy in newborns using lowcost devices-ice packs and phase changing material[J]. Paediatr Int Child H, 2019, 39(4): 234239.[ZK)]-
[11]张丽燕,符爱兰,韩惠芳,等.集束化保温干预对急诊创伤患者自发性低体温发生情况及凝血功能的影响[J].中国实用护理杂志,2020,36(4):293-297.
[12]宗卿,杨丽君,林茹.紧急低温全晶体灌注循环抢救幼儿失血性休克心跳骤停1例[J].中国体外循环杂志,2018,16(4): 245-247.
[13]DRUMHELLER B C, STEIN D M, SCALEA T M. Use of an intravascular temperature control catheter for rewarming of hypothermic trauma patients with ongoing hemorrhagic shock after combined damage control thoracotomy and laparotomy: A case series[J]. Injury, 2018, 49(9):1668-1674.
[14]涂加园,聂时南,韩小琴,等.急诊创伤患者低体温院内评估处置现况调查[J].护理学杂志,2019,34(7):15-18.
[15]兰凯,赖西南,张良朝,等.局部低温对失血性休克兔肢体缺血再灌注损伤的影响[J].中华麻醉学杂志,2018(2):230-233.
[16]TRAN A, YATES J, LAU A, et al. Permissive hypotension versus conventional resuscitation strategies in adult trauma patients with hemorrhagic shock: A systematic review and metaanalysis of randomized controlled trials[J]. J Trauma Acute Care Surg, 2018, 84(5):802-808.
[17]姚晓丽,金培英,陆关珍,等.集束化干预策略在创伤失血性休克患者输血准备中的应用[J].全科医学临床与教育,2019,17(5):428-431.
[18]韩春彦,贺莉,赵存,等.创伤后自发性低体温影响因素及干预措施的研究进展[J].中国护理管理,2019,19(10):1552-1557.