| Background: Hemorrhagic-traumatic Shock is one of the leading criticalillnesses in the emergency department. HTS is a whole body blood, oxygendeficiency disease in which the body suffers after a severe blow. It has aninadequate tissue and organ perfusion as its main pathological, physiologychanges of systemic disease. If not timely or effectively treated, may lead toshock, infection or even lead to other serious consequences such as sepsis,acute respiratory distress syndrome (ARDS) and multiple organ dysfunctionsyndrome (MODS) and sometime even death may occur. HTS is oftenassociated with multiple trauma which is severe and rapidly changing. It is theearly modern trauma leading cause of death. This data indicates that, if apatient lost30%of blood, that traumatic patient is considered to be in alife-threatening condition and if not effectively treated within the shortestpossible time,32.6%-59.5%of such patient may died of Hemorrhagic Shock[9].The treatment involves a quick addition of volume to correct the hemodynamicdisorders, improve the microcirculation of tissues and organs, to maintain tissueoxygen delivery and utilization. After the occurrence of shock, if not promptlycorrected, patient may die due to persistent breakdown in microcirculationcaused by cell and organ dysfunction and it is life-threatening[8].The treatmentof HTS include: a rapid assessment of injury, unobstructed airway, monitoringof vital signs, establishing intravenous infusion and preparing the blood, perfectrelevant inspection diagnosis, routine preoperative preparation, and so on. Oneof the most effective measures is to perform an emergency definitive surgery inorder to control active bleeding. However, deterministic methods are notalways successful in stopping immediate bleeding. Therefore, definitive surgery before the implementation of the recovery needs to take effectivemeasures to restore organ perfusion and tissue oxygen supply. So, a timely andeffective fluid resuscitation in patients with HTS needs to focus on earlytreatment, it must be established quickly and efficiently through an emergencyfluid resuscitation. However, for patients with traumatic hemorrhagic shock,due to sharp reduction in effective circulating blood volume, limb superficialveins, poor circulation, peripheral venous contraction collapse, often causedpuncture difficult or difficulties in establishing peripheral intravenousaccess. Central venous catheterization (CVC) operation has certain degree ofdifficulty. It requires an extensive clinical experienced physician to complete,and the puncture process may occur in severe or even fatalcomplications. Phlebotomy is time-consuming, permanent damage, and onlyone-time use. At this point, we use Intraosseous access as an emergencyvascular access if the traditional intravenous access is difficult orimpossible. In a Shock state, the medullary cavity of the venous plexus doesnot collapse which is different from peripheral vein. Through intraosseousinfusion, the drug and the liquid can quickly enter into the blood circulation andhave the same dose and transfusion speed. Intraosseous infusion has alreadybeen considered a new method of resuscitation[5]. It access is more safe andefficient as compared to the central venous catheterization. And it can achievethe same drug concentration with the intravenous infusion[6]. In addition, thebone marrow cavity infusion technique is simple, fast, safe and effective[7], it isan effective alternative to intravenous access for emergency treatment, reliablycycle of reconstruction, and does not affect the CPR. Bone marrow puncturingtime is short, the success rate of the operation is high, and no high proportion ofsevere complications is observed. In order to save time, improve the successrate of the treatment in critically ill patients along with the clinical work andrelated experimental study unceasingly through the bone marrow cavity infusion technology (Intraosseous Infusion, IOI) re-aroused the people’s interestand concerns[4]. It has been recognized in the international community, and hasgradually been accepted by experts and professors in our country.Objective: Explore an emergency rescue of uncontrolled hemorrhagicshock trauma patients with effective method and its infusion channel inuncontrolled hemorrhagic shock trauma emergency treatment effect in theprocess of observation.Methods: From October2009to October2011in the emergencydepartment of China-Japan Union Hospital of Jilin University78patients withHTS were recruited. In other rescue measures, the same circumstances,78cases were retrospectively analyzed.36cases with the Intraosseous access and42patients with venous infusion．Results: Compared with intravenous infusion group， IntraosseousInfusion group was performed in a significantly short period of time, thedifferences between two groups were statistically significant (P<0.01); tworescue to recovery time, no significant difference in blood pressure, notstatistically significant (P>0.05); two groups at normal pressure and underpressure infusion pump infusion rate, no significant difference was statisticallyfound (P>0.05); complication rate compared with intravenous infusion of bonemarrow infusion group was significantly reduced, the difference wasstatistically significant (P<0.01).Conclusion: The infusion of bone marrow cavity in the rescue oftraumatic hemorrhagic shock patients, the role of fast, safe, effective,emergency infusion of bone marrow cavity of the channel into the infusion timewas significantly shorter time for the rescue to win. An infusion of bonemarrow cavity puncture success rate and treatment success rate improvedsignificantly, with a clear recovery of efficacy and safety. Marrow infusion asan intravenous infusion channel can be an effective alternative means to meet the patient’s fluid, expansion needs, traumatic hemorrhagic shock patient’schances of survival, effectively improve the treatment success rate. |
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