Clinic effect and prognosis analysis of different emergency fluid resuscitation methods for hemorrhagic shock following severe pelvic fractures

Cui Ruihong; Luo Heng; Qu Lijuan; Yin Wen; Li Junjie; Wang Qianmei; Xu Yunyun; Wang Jiao; Huang Yang

doi:10.3969/j.issn.1009-4237.2024.08.005

Abstract：Objective To explore the clinical effect and prognosis of different emergency fluid resuscitation methods in the treatment of hemorrhagic shock following severe pelvic fractures.Methods A total of 96 patients with severe pelvic fractures and hemorrhagic shock admitted to our hospital from Jun.2021 to Jun.2023 were pro-spectively selected as the study objects.Among the 96 patients,56 were male and 40 were female,with an average age of 38.6 years.The main cause of injuries was road traffic accidents(51 cases),followed by falls(24 cases)and crushing injuries(21 cases).The patients were divided into study group(48 cases)and control group(48 ca-ses)according to the random number table method.After admission,all patients underwent surgical emergency treatment such as hemostasis,external fixation of fractures,routine monitoring of vital signs,establishment of venous channels,and blood routine exam.Patients in the control group were subjected to routine rapid fluid resuscitation,supplemented with sufficient equilibrium fluid,colloidal fluid,suspended red blood cells,plasma,etc.,while those in the study group were subjected to restricted fluid resuscitation,with appropriate input of hypertonic sodium chloride solution in the early stage and then input of equilibrium fluid.The vital sign indexes at 3 d after resuscitation,coagu-lation indexes,acute physiological and chronic health Ⅱ(APACHE Ⅱ)scores,electrolyte levels,and inflammatory factors levels at admission,30 min and 1 h after resuscitation were compared between the two groups.The differ-ences in prognostic indexes were also observed.Results The whole heart end diastolic volume index(GEDVI),cardiac index(CI),cardiac output volume(CO),oxygenation index(Pa02/FiO2),mean arterial pressure(MAP)and central venous pressure(CVP)at 3 d after resuscitation increased while blood lactate(LAC)and heart rate(HR)decreased,all revealing significant difference compared with those on admission(P＜0.05);moreover the abovementioned vital signs were much better in the study group than in the control group(all P＜0.05).At 3 d after resuscitation,TT,PT and APTT were higher than those on admission and APACHE-Ⅱ scores were lower(all P＜0.05);further comparison between study and control groups showed much lower results of TT,PT,APTT and A-PACHE-Ⅱ scores in the study group(all P＜0.05).At 3 d after resuscitation,the levels of Na+increased and K+decreased compared with those on admission(P＜0.05),however,comparison between the two groups showed no significant difference regarding Cl-,Mg2+,Na+and K+levels(P＞0.05).Repeated measurement ANOVA showed that there were statistically significant differences in the timing,intergroup and interaction effects of Y-interferon(y-IFN),interleukin-4(IL-4),interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)between the two groups(P＜0.05).The y-IFN,IL-4,IL-6 and TNF-α levels at 30 min and 1 h after resuscitation in both groups were signifi-cantly higher than those before treatment,and moreover much higher at 1 h after resuscitation than at 30 min after re-suscitation(all P＜0.05).At both 30 min and 1 h after resuscitation,the y-IFN,IL-4,IL-6 and TNF-α levels in the study group were all lower than those in the control group(all P＜0.05).As for the complications of acute respirato-ry distress syndrome(ARDS),disseminated intravascular coagulation(DIC),multiple organ dysfunction syndrome(MODS),acute renal failure(ARF),pulmonary infection and abdominal infection,the separate incidence showed no significant difference between the two groups(P＞0.05),but the total incidence of complications and mortality rate in the study group were lower than those in the control group(8.3％vs.37.5％and 2.1％vs.16.7％,both P＜0.05).Conclusion The limited emergency fluid resuscitation method for hemorrhagic shock after severe pelvic fractures has a good therapeutic effect,which can effectively improve the vital signs of patients,correct the coagula-tion disorder,reduce the inflammatory reaction,reduce the risk of complications,and improve the prognosis.