Clinical Application Of Limited Fluid Resuscitation In Severe Brain Injury With Hemorrhagic Multiple Traumatic Shock

Objective To explore the principle of the limited fluid resuscitation about severe brain injury combined with hemorrhagic multiple traumatic shocks.Method 128 cases of severe brain injury combined with multiple traumatic and hemorrhagic shocks,treated by neurosurgery department of our hospital from January 2007 to January 2015,were involved in the study.The patients were divided into two groups according to the method of fluid resuscitation.In group A,patients received aggressive fluid resuscitation,in group B,patients received limited fluid resuscitation.Patients in group B were divided into two subgroups(B1 or B2)according to the type of the fluid.In group B1,patients were received Hydroxyethyl Starch(HES)and Sodium Lactate Ringers' injection(LR),and in group B2,patients were received HES and 7.5% Hypertonic Sodium Chloride Solution(HS).Hemodynamic index was measured strictly.In group B according to restrictive rehydration principle,the mean artery pressure(MAP)was controlled within 70~80 mmHg and central venous pressure(CVP)was controlled within 6~8 cmH2 O,both was maintained within 48 hours.Based on the different types of resuscitation liquids,group B was divided into subgroup B1(HES+LR)and subgroup B2(HES+7.5% HS)(2 ~ 4ml/kg).In group A,the ratio of LR and HES was 2~3:1 were infused to restore effective circulation volume as soon as possible,in order to elevate the blood pressure at the basic level and CVP within 8~12 cmH2 O.The rest of the treatment was basically the same.Such items as Glasgow coma scale(GCS),shock index,coagulation function,image data,the incidence of ARDS and MODS,Glasgow outcome scale(GOS)for 6 months of survivors were studied among the different groups.Result The shock indexes of three groups were all improved.By comparison of group A,group B1 and group B2,there were significant difference in the image data,the incidence rate of ARDS and MODS,GCS scores(P<0.05).16 cases suffered with intracranial hemorrhage in deteriorate,15 cases with ARDS,and 14 cases with MODS in group A were more than these in group B1 and B2(P<0.05),the scores of GCS were lower too.These index was not statistical significant between B1 and B2(P>0.05).The coagulation in group B was better than ones in group A,but no difference between group B1 and B2.The total volume of fluid was statistical different among the three groups(P<0.05).GOS of the patients followed up for 6 months in group B were higher than that in group A(P<0.05).Conclusion Both aggressive fluid resuscitation and limited fluid resuscitation can rectify the hemorrhagic shock in severe brain injury combined with multiple traumatic injury patients.Limited fluid resuscitation is superior to aggressive fluid resuscitation in treating coagulation disorders,reducing probability of intracranial hemorrhage in deteriorate,reducing the incidence of ARDS and MODS,and increasing the score of GOS after six months after injury.Application of 7.5% HS can reduce the infusion volume and it is also possible to prevent the adverse effects of the internal environment on the early stage of shock.