Clinical effect of nursing care with hypotensive resuscitation in patients with uncontrolled hemorrhagic shock

XIAO Xia; ZHAO Jian-mei

doi:10.3969/j.issn.1009-4237.2018.02.020

Abstract：Objective To investigate the clinical application and nursing effect of hypotensive resuscitation in treating patients with uncontrolled hemorrhagic shock.Methods A retrospective study was used to investigate 855 patients with uncontrolled hemorrhagic shock from Jun.2011 to Jun.2016,who were divided into 2 groups.In hypotensive resuscitation group(573),preoperative"limited fluid resuscitation"was used to maintain a systolic blood pressure of 80-85mmHg,and the amount of fluid was less than 1000mL.In control group(282),preoperative"aggressive fluid resuscitation"was used with fluid amount over 2000mL,and systolic blood pressure was maintained above 85mmHg.Parameters such as blood demand quantity,death rate,early postoperative complications and blood coagulation were compared between the two groups.Results Overall mortality was 9.2%(79/855).Of the deaths,53.2%died of exsanguination associated with coagulopathy.In the survivors,cured postoperative complica-tions included coagulopathy(131),abdominal compartment syndrome(11),overload transfusion(71),acute lung in-jury(70)and mild cardiac failure(46).Between the two groups,the amount of fluid required,the death cases,early postoperative complication,laboratory coagulation parameters,and prolonged ICU time(≥7d)were all significant(P<0.05).Conclusion To manage uncontrolled hemorrhagic shock,hypotensive resuscitation with hemostatic re-suscitation is a wise option,which decreases the mortality and morbidity.Key measure for nursing care is the control of blood pressure and time of fluid resuscitation,and the administration of coagulative factors.Key points for compli-cation care is"lethal triad"including coagulopathy,hypothermia,and acidosis.