Application evaluation of field blood transfusion pressure device in intraoperative rescue of hemorrhagic shock
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摘要: 失血性休克(hemorrhagic shock，HS)具有出血量大、进展快和死亡率高的特点，约占入院后24 h内所有死亡人数的50%，战创伤HS也是伤员主要死亡原因之一。及时有效地止血和快速输血补液是挽救患者生命的关键，采用加压快速液体复苏是最有效的措施之一。文章回顾性分析了2020年6月—2022年12月分别采用不同的加压装置对78例HS患者进行了术中抢救，取得了良好的救治效果。其中自主研制的输血加压器性能更好，平战时抢救大量失血患者均可使用，值得医院手术室作为急救器材推广应用。Abstract: Hemorrhagic shock(HS) was characterized by massive hemorrhage, rapid progression and high mortality, accounting for about 50% of all deaths within 24 hours of admission, and war trauma hemorrhagic shock was also one of the main causes of death. Timely and effective hemostasis, rapid blood transfusion and fluid replacement were the key to save the lives of patients.The rapid fluid resuscitation with pressure was one of the most effective measures. A total of 78 patients with hemorrhagic shock were retrospectively analyzed who were treated with different compression devices from June 2020 to December 2022, and achieved good results.The independently developed blood transfusion pressurizer has better performance and could be used to rescue patients with massive blood loss in peacetime and wartime. It was worth popularizing and applying as first-aid equipment in hospital operating room.
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表 1 三种加压方式效果比较
加压方式 比较项目 总体评价 施压范围/kPa 压力波动 血液流速/(mL/min) 人为干预 截流保护 残余量/mL 对血液质量影响 加压器 5~10 小 50~80 否 是 < 15 否 优 加压袋 0~40 大 40~100 是 否 < 15 可能 良 手动 手控 大 不均匀 是 否 < 15 可能 可 
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表 2 三种加压方式输注前后对血液指标的影响
X±S 加压方式 例数 血液检测指标 Hb/(g/L) Hct/% K+/(mmol/L) APTT/s CFHb/(g/L) P/% 手动 23 输注前 63±0.32 18.7±3.44 4.15±0.78 75.4±20.3 0.102±0.004 0.039±0.002 输注后 86±0.54 25.2±4.10 5.41±0.82 40.0±12.1 0.185±0.033 0.117±0.014 加压袋 25 输注前 60±0.26 17.9±3.05 3.98±0.78 69.6±18.7 0.097±0.003 0.044±0.003 输注后 91±0.60 29.2±4.20 5.27±0.85 45.1±16.3 0.167±0.022 0.098±0.012 加压器 30 输注前 58±0.30 18.1±3.00 4.33±0.80 70.7±19.0 0.100±0.004 0.033±0.001 输注后 93±0.72 31.7±4.31 4.85±0.66 42.4±14.3 0.134±0.006 0.069±0.002 注：各组间输注前后比较均差异无统计学意义(P>0.05)。
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