Features and prevention of complications after severe traumatic hemorrhagic shock in plateau / 中华创伤杂志

ABSTRACT

Objective To investigate the features and prevention measures of complications secondary to severe traumatic hemorrhagic shock (THS) of different crowds in plateau (3 658 meters above the sea level).Methods A retrospective study was conducted on 591 severe THS patients undergone traditional resuscitation (traditional resuscitation group,n =103) from October 1976 to October 1990 and integrated treatment (integrated treatment group,n =488) from October 1991 to October 2012.The patients included native Tibetans,Han immigrants in plateau (≥ 3 months) and Han people who entered plateau rapidly (＜ 7 days).Outcome of the two treatments was compared.Results With regard to the traditional resuscitation group,native Tibetans sustained the main complications including stress ulcer (n =2),pulmonary edema (n =1),MODS (n =3) and death (n =3) ； Han immigrants in plateau sustained the main complications including stress ulcer (n =9),pulmonary edema (n =8),ARDS (n =3),cerebral edema (n =1),acute renal failure (n =3),disseminated intravascular coagulation (DIC) (n =2),MODS (n =13) and death (n =11)； Han people who entered plateau rapidly sustained the main complications including stress ulcer (n =5),pulmonary edema (n =4),ARDS (n =4),cerebral edema (n =2),acute renal failure (n =3),DIC (n =2),MODS (n =6) and death (n =4).Whereas in contrast to the relevant patient crowds in the traditional resuscitation group,the native Tibetans,Han immigrants in plateau and Han people who entered plateau rapidly presented significant reduction of complication rate and mortality rate in the integrated treatment group.Conclusions (1) Traditional resuscitation for severe THS patients in plateau results in much more complications with quick occurrence,high incidence,rapid progression,high severity and high mortality.Moreover,the complications are more severe in Han people who entered plateau rapidly than in the Han immigrants in plateau and native Tibetans.(2) The incidence of complications and death rate are significantly reduced after integrated treatment.(3) Han people who entered plateau rapidly present larger dependence on integrated treatment than the Han immigrants in plateau and native Tibetans.