【摘要】 目的探讨通过颈外静脉补液在失血性休克抢救中的作用。方法选择急诊失血性休克患者78例,ASAⅢ～Ⅳ级,均分为三组各26例。外周静脉组(C组):患者进入手术间建立两路外周静脉通路;颈内静脉组(I组):患者进入手术间建立一路外周静脉和颈内静脉通路;颈外静脉组(E组):患者进入手术间建立一路外周静脉和颈外静脉通路。观察三组患者进入手术间(T0)、麻醉前、平均动脉压(mean arterial pressure,MAP)和心率(heart rate,HR)平稳时(T2)和手术结束时MAP、HR、血红蛋白(HB)和碱剩余(BE);记录三组患者T0、麻醉时(T1)、T2的时间、血管活性药物使用量和次数、补液种类和总量。结果与T0比较,三组BE在麻醉前、T2以及手术结束时均降低(P<0.05);与C组和I组比较,E组BE在麻醉前、T2时均降低(P<0.05);与C组和I组比较,E组在T1、T2和碳酸氢钠使用量、去氧肾上腺素使用量和使用次数上均减少(P<0.05)。结论通过颈外静脉补液能快速改善失血性休克状态,减少血管活性药物的使用,缩短微循环改善和血压恢复所需时间,促进重要脏器功能恢复。更多还原

【Abstract】 Objective To evaluate the effect of correcting hemorrhagic shock inpatients who supplying blood volume with external jugular vein improves.Methods 78 patients suffering from hemorrhagic shock(ASA Ⅲ～Ⅳ),were randomly divided into 3 groups: group C(the peripheral vein group),group I(the internal jugular vein group) and group E(the external jugular vein group),26 cases of each group.The fluid resuscitation was performed by two path of peripheral vein In group C,one path of peripheral vein and one path of internal jugular vein in group I and one path of peripheral vein and one path of external jugular vein in group E.The mean arterial pressure(MAP) 、heart rate(HR) 、hemoglobin(HB) and base excess(BE) were observed at the time when arriving the operation room(T 0),before anesthesia(T 1),the time when MAP and HR were stable(T 2) and when the operation was completed(T 3).The dose and frequency of vasoactive agent and the kind and amount of fluid were recorded.Results The BE was significantly decreased at the time of T 1,T 2,andT 3,than T 0(P < 0.05).The BE in group E was significantly decreased at he time of T 1 andT 2 than group I and group C(P < 0.05).In group E,the dose and frequency of phenylephrine and the dose of sodium bicarbonate significantly decreased compared than other two groups(P < 0.05).Conclusion The fluid resuscitation by external jugular vein can quickly correct the hemorrhagic shock,and decrease the dose of vasoactive agent,shorten the period of improving the microcirculation and recovering of the blood pressure.and promote the recovery the function of the important orgens.更多还原