Clinical Research Of Limited Fluid Resuscitation For The Treatment Of Traumatic Uncontrolled Hemorrhagic Shock

ObjectiveThe statistics of 2014 from World Health Organization(WHO) : every year there are about 1.75 million youth of the world dead for a variety of trauma. Around the world, apparently the trauma has become the main cause in youth death and disability. According to "China Injury Prevention Report"(published in 2011 by the Chinese Ministry of Health),every year about 200 million passengers injury and 70 million to 75 million dead, the total number of deaths in the country accounts for about 9%, it is also more common in young adults, and the disease is often more severe, The years to the loss of potential life caused by trauma exceeds any other disease. And the patients died of hemorrhagic shock in trauma accounted for more than 40%, most occurred within 6h after trauma. Therefore, in order to reduce mortality, the key should be effective early fluid resuscitation. So, the study of the way to recovery has a very important significance for the treatment of trauma patients with hemorrhagic shock and reduces mortality. Through the first study, to observe and analysis the role of the limited fluid resuscitation on the early trauma of uncontrolled hemorrhagic shock patients about blood clotting function, acidosis, mortality and-8-complications,To investigate the effect of early fluid resuscitation of trauma patients with hemorrhagic shock. Through the second study, the randomized controlled trials(RCT) about the efficacy of limited fluid resuscitation and conventional fluid resuscitation in traumatic hemorrhagic shock were searched on Pub Med, Embase, The Cochrane Library, Chinese Biomedical Literature Database(CBM) and China Journal Full-text Database(CNKI). By extracting data and assessing methodological quality, Meta-analysis was conducted by the Cochrane Collaboration Rev Man5.3 software. To evaluate the efficacy of limited fluid resuscitation and conventional fluid resuscitation of traumatic hemorrhagic shock,and to provide evidence for the clinical treatment decisions. MethodsThe first study: During the period from 2012 February through2013 October,113 patients who are severe multiple injury and uncontrolled hemorrhagic shock,rescued by emergency department of our hospital. According to the different method of resuscitation,divided into the regular fluid resuscitation group(regular group) and limited fluid resuscitation group( limited group). Regular group of 50 cases,limited group 63 cases. Comparison of different resuscitation group between preoperative infusion volume, blood coagulation function(PT and APTT),platelet, hemoglobin,base excess(BE),plasma lactic acid content,mortality,acute respiratory distress syndrome(ARDS) and multiple organ dysfunction syndrome(MODS)incidence rate.The second study: The randomized controlled trials(RCT) about the efficacy of limited fluid resuscitation and conventional fluid resuscitation in traumatic hemorrhagic shock were searched on Pub Med, Embase, The Cochrane Library, Chinese Biomedical Literature Database(CBM) and China Journal Full-text Database(CNKI). By extracting data and assessing methodological quality, Meta-analysis was conducted by the Cochrane Collaboration Rev Man5.3 software.The third study: The randomized controlled trials(RCT) about the efficacy of 7.5g/L sodium chloride resuscitation and isotonic crystalloid resuscitation in traumatic hemorrhagic shock were searched on Pub Med, Embase, The Cochrane Library, Chinese Biomedical Literature Database(CBM) and China Journal Full-text Database(CNKI). By extracting data and assessing methodological quality, Meta-analysis was conducted by the Cochrane Collaboration Rev Man5.3 software. ResultsThe first study: Compared with limited group,regular group,s PT,APTT,and the content of serum lactic acid value increased obviously, platelet,hemoglobin and BE markedly reduced(P<0.05); Compared with regular group, Limited group,s mortality and the incidence of ARDS and MODS declined obviously(P <0.05).The second study: Six articles and 2168 patients were included,1027 cases of limited fluid resuscitation, 165 cases of death;1141 cases of conventional fluid resuscitation, 211 cases of death. The results of Meta-analysis of mortality indicated that: [RR= 0.86, 95%CI: 0.72,1.02; P=0.09], The results of Meta-analysis of hemoglobin indicated that: [WMD= 2.47, 95%CI: 2.33,2.62;P=0.00001]. The results of Meta-analysis of PT indicated that: [WMD=-1.86, 95%CI:-3.14,-0.58;P=0.004]. The results of Meta-analysis of PTT indicated that: [WMD=-4.44, 95%CI:-6.72,-2.16;P=0.0001].The third study: Five articles and 1025 patients were included, The results of Meta-analysis of sodium concentration indicated that: [WMD= 7.92, 95%CI: 7.23,8.60; P<0.00001], The results of Meta-analysis of the magnitude of changes in blood pressure before and after resuscitation indicated that: [WMD= 8.45, 95%CI: 2.84,14.07; P=0.003]. The results of Meta-analysis of hemoglobin indicated that: [WMD=-7.17, 95%CI:-10.51,-3.82;P<0.0001]. The results of Meta-analysis of hospital mortality indicated that: [RR=1.00 95%CI: 0.82,1.22;P=0.99]. ConclusionWith early limited fluid resuscitation, improving the coagulation function of patients,alleviated acidosis, reducing the mortality and the incidence of ARDS and MODS, improving the prognosis. Displaying through the meta-analysis of existing clinical data, There is significant difference between limited fluid resuscitation and conventional fluid resuscitation in hemoglobin, PT and PTT, and limited fluid resuscitation has the better clinical effects; but in terms of mortality in both groups is not statistically significant.75g/L Na Cl hypertonic saline compared with isotonic crystalloid fluid resuscitation, 75g/L Na Cl hypertonic saline resuscitation has an earlier and faster resuscitation to restore blood pressure goals, the reduced hemoglobin content and hypernatremia generated by 75g/L Na Cl hypertonic saline is generally safe and effective, and in-hospital mortality is similar with isotonic crystalloid.