失血性休克的损伤控制复苏中肾阻力指数对急性肾损伤的预测价值

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1、授予单位代码１００８９学号或串请号１３３９３巧忘钟ＡＳＨ化ｅｉＭｅｄｉｃａｌＵｎｉｖｅｒｓｉｔｙ硕±学位论文在职科学学位失血怯休克的损伤控制复苏中肾阻力指数对急性肾损伤的预测价值学位申请人；石秀霞导师：刘丽霞教授朗振杰教授专业：急诊医学二级学院：第四医院２０１５年１０月巧北医科大学学位论义使用授权及知识产权归属承语本学位论文在导师（或指导小组）的指导下，由本人独立完成。本学位论文研究所获得的研究成果，其知识产权巧河北医科大学所有。河北医科大学有权对本

2、学位论文进行交流、公开和使用。凡发表与学位论文主要内容相关的论文一，第署名为单位河北医科大学，试验材料、原始数据、申报的专利等知识产权均归河北医科大学所有。否则，承担相应法律责任。导师签章：研究生签务：级学院领导盖章＾年月曰户乂，，作河北医科大学研究生学位论文独创性声明本论文是在导师指导下进行的研究工作及取得的研究成果，除了文中特别加标注和致谢等内容外，文中不包含其他人已经发表或撰写的研究成果，指导教师对此进行了审定。本絶文由本人独立撰写，文责自负。：导师签章研究生签名：ｆ山；年／月Ｗ日

3、目录中文摘要··············································································1英文摘要··············································································5研究论文失血性休克损伤控制复苏策略中肾阻力指数对急性肾损伤的预测价值前言···································································

4、···········9材料与方法·····································································11结果··············································································15附图··············································································18附表··················

5、····························································19讨论··············································································22结论··············································································27参考文献··········································

6、······························27综述超声技术在评价重症患者肾脏血流灌注中的应用···················31致谢····················································································41个人简历··············································································42中文摘要失血性休克损伤控制复苏策略中肾阻力指数对

7、急性肾损伤的预测价值摘要目的：在过去的十几年里，国内、外学者对于严重创伤失血性休克的救治措施进行了大量研究和探索，在复苏和输血策略方面有了很大的改变。过去经典的休克复苏方式由于会导致血液被稀释及凝血因子大量丢失而加重急性创伤性凝血病（acutetraumaticcoagulopathy,ATC）病情，同时大出血和大容量液体补充又会引起体温下降，进一步加重凝血障碍和酸中毒的进展，成为对此类创伤患者生命的最大威胁。当前损伤控制复苏（damagecontrolresuscitation,DCR）与损伤控制外科（damagecontrolsurg

8、ery,DCS）联合的策略，已经广泛应用于创伤失血性休克的伤员中，特别是出血未被控制的、无其他严重合并症的胸腹联合损伤的年轻人群。这种复苏模式明显减少了液体输注的总量，维持血压在一个较低的水平