Staged liquid resuscitation capacity regulation and control method and system for patient with traumatic hemorrhagic shock

Abstract

The invention belongs to the technical field of critical disease monitoring, and particularly relates to a staged liquid resuscitation capacity regulation and control method and system for traumatic hemorrhagic shock patients, and the resuscitation process is sequentially divided into four core stages of initial resuscitation, resuscitation optimization, stable monitoring and capacity reactivity evaluation. And clear physiological targets, monitoring parameters and advanced or return standards are set in each stage. According to the method, multiple vital signs and laboratory indexes are subjected to dynamic and tendency analysis, and a complete and standardized decision path from positive resuscitation to stable evacuation is provided for clinicians. The invention not only aims at effectively recovering tissue perfusion, but also aims at reducing the risk of complications such as rebleeding, blood clotting disease and cardiac insufficiency caused by excessive resuscitation or misjudgment of illness conditions to the greatest extent, so that a safer and more reliable practice framework is provided for improving clinical prognosis of patients suffering from traumatic hemorrhage shock.

Description

TECHNICAL FIELD

[0001] The present application belongs to the technical field of critical illness monitoring, and in particular relates to a phased fluid resuscitation volume control method and system for patients with traumatic hemorrhagic shock. BACKGROUND

[0002] Traumatic hemorrhagic shock is a common critical illness in clinical practice. Its core pathophysiological link is the insufficient tissue perfusion and hypoxia caused by the rapid decrease of effective circulating blood volume. Traditional fluid resuscitation strategies often emphasize early and rapid replenishment of a large amount of fluid to quickly elevate blood pressure and restore circulatory stability. However, more and more clinical observations and researches have shown that this extensive resuscitation method without precise control may lead to a series of complications. For example, without effective control of the bleeding source, excessive elevation of blood pressure may dislodge the formed thrombus, exacerbating bleeding; and excessive infusion of crystalloid fluid may easily cause dilution coagulopathy, hypothermia, and tissue edema, especially pulmonary edema and abdominal compartment syndrome, which may worsen the patient's condition and increase mortality.

[0003] Although existing clinical guidelines have recognized the above risks and proposed concepts such as "damage control resuscitation", in actual operation, they often lack a clear, coherent, multi-stage, and fine volume control process based on dynamic monitoring feedback. Many schemes only provide general targets and principles, and fail to provide systematic and step-by-step specific steps and judgment criteria for how to smoothly transition from initial resuscitation to optimization phase, how to accurately determine whether the volume status has truly met the requirements, and how to identify whether continued fluid infusion is beneficial to the patient. This leads to the fact that in emergency clinical practice, treatment still largely depends on the personal experience of physicians, resulting in large differences in decision-making and inaccurate volume management.

[0004] Therefore, there is an urgent need in the art for a phased fluid resuscitation scheme that can be applied throughout the entire treatment process of patients with traumatic hemorrhagic shock. Such a scheme should be able to integrate hemorrhage control, volume resuscitation, organ perfusion assessment, and cardiac function evaluation into a standardized process. It needs to abandon single and static indicators and instead rely on the dynamic and continuous changes in multiple hemodynamic parameters and metabolic indicators to guide treatment decisions, thereby achieving individualized and fine-tuned control from emergency resuscitation to stable maintenance and then to withdrawal assessment. The ultimate goal is to restore effective perfusion while minimizing the risk of volume overload and related complications. SUMMARY

[0005] According to a first aspect of the present application, the present application claims a phased fluid resuscitation volume control method for patients with traumatic hemorrhagic shock, comprising the following steps: S1, infusing crystalloid fluid to a patient to be regulated in an initial resuscitation stage, continuously monitoring mean arterial pressure and heart rate of the patient to be regulated, and determining that the initial resuscitation stage ends and enters an optimization resuscitation stage when the mean arterial pressure rises to a first predetermined threshold and the heart rate drops to a second predetermined threshold; S2, slowing down the infusion speed and switching to infusing colloid fluid in the optimization resuscitation stage, and starting to monitor central venous pressure and urine output of the patient to be regulated, and maintaining the central venous pressure in a specific pressure range and the urine output in a specific flow range by adjusting the infusion rate of the colloid fluid, and entering a stable monitoring stage after a predetermined stable time; S3, suspending active fluid infusion in the stable monitoring stage, and monitoring vital sign parameters of the patient to be regulated, and entering a volume responsiveness evaluation stage if the mean arterial pressure and the central venous pressure of the patient to be regulated remain stable within a predetermined observation period, and returning to the optimization resuscitation stage if a downward trend occurs; S4, performing a passive leg raising test on the patient in the volume responsiveness evaluation stage, and continuously monitoring changes in heart rate and mean arterial pressure of the patient to be regulated, and determining that the patient to be regulated has volume responsiveness if the mean arterial pressure rises by more than a predetermined change value and the heart rate drops by more than another predetermined change value after the passive leg raising test, and returning to the optimization resuscitation stage for supplementary infusion, and determining that the patient has no volume responsiveness if the changes do not reach the predetermined change values, maintaining the current fluid balance state, and ending the fluid resuscitation regulation.

[0006] Further, in the step S1, the arterial blood lactate level of the patient is also monitored synchronously while infusing crystalloid fluid; When the mean arterial pressure and the heart rate reach the first predetermined threshold and the second predetermined threshold, and the arterial blood lactate level starts to show a downward trend, it is determined that the initial resuscitation stage ends.

[0007] Further, in the step S2, the dynamic changes in the arterial blood lactate level are also continuously tracked while monitoring the central venous pressure and the urine output; In the optimization resuscitation stage, the arterial blood lactate level is ensured to continuously decrease below a safety threshold while the central venous pressure and the urine output reach the specific ranges.

[0008] Further, in the step S3, the vital sign parameters closely observed also include the arterial blood lactate level; The criteria for determining that the vital signs remain stable also include that the arterial blood lactate level does not show a rebound phenomenon within the predetermined observation period.

[0009] Further, in the step S4, if it is determined that the patient has no volume responsiveness, a heart function evaluation step is further started; The myocardial contractility of the patient is evaluated by clinical examination, and if the myocardial contractility is found to be weakened, a cardiotonic drug is used for therapeutic intervention.

[0010] Further, before the step S1, a pre-control step is further included: rapidly evaluating whether the patient has active bleeding; if it is confirmed that the patient has active bleeding, a definitive hemostasis measure is immediately taken while fluid resuscitation is performed; the definitive hemostasis measure includes surgery or interventional embolization.

[0011] Further, in the step S2, the colloidal solution is a hydroxyethyl starch solution or a gelatin solution. The specific way of adjusting the infusion rate of the colloidal solution is to accelerate the infusion when the central venous pressure is lower than the lower limit of the specific pressure range, and to slow down or suspend the infusion when the upper limit is approached or reached.

[0012] Further, in the steps S3 and S4, the body temperature of the patient is monitored and maintained, the core body temperature of the patient is maintained within a normal physiological range by using a warming infusion device and a warming blanket, so as to avoid the influence of low body temperature on the accuracy of hemodynamic parameters and coagulation function.

[0013] Further, the method further includes a continuous bleeding and coagulation monitoring step during the whole execution process: The hemoglobin concentration and coagulation function indicators of the patient are regularly checked; If the hemoglobin concentration decreases progressively or the coagulation function is abnormal during fluid resuscitation, a warning signal is sent out, which indicates that there may be undetected continuous bleeding or coagulopathy, and re-evaluation and intervention are needed; In the step S4, the operation standard of the passive leg-raising test is: The patient is changed from a supine position to a position in which both legs are raised at a predetermined angle, the position is maintained for a predetermined time, and an ultrasonic probe placed on the body surface of the patient is used to monitor the change of the blood flow velocity in the femoral vein during the whole process, and the increase amplitude of the blood flow velocity is used as an additional index for assisting in judging the volume responsiveness.

[0014] According to the second aspect of the present application, the present application claims to protect a phased fluid resuscitation volume control system for a patient with traumatic hemorrhagic shock, comprising: one or more processors; a memory having one or more programs stored thereon, when the one or more programs are executed by the one or more processors, the one or more processors implement the phased fluid resuscitation volume control method for a patient with traumatic hemorrhagic shock.

[0015] The present application belongs to the technical field of critical illness monitoring, and particularly relates to a phased fluid resuscitation volume regulation method and system for a trauma hemorrhagic shock patient, wherein the resuscitation process is sequentially divided into four core stages of initial resuscitation, optimized resuscitation, stable monitoring and volume reactivity evaluation, and each stage is provided with clear physiological targets, monitoring parameters and progression or return standards. The present application provides a complete and standardized decision-making path from active resuscitation to stable evacuation for clinicians through dynamic and trend analysis of multiple vital signs and laboratory indicators. The present application not only aims to effectively restore tissue perfusion, but also focuses on minimizing the risks of complications such as rebleeding, coagulopathy and cardiac insufficiency caused by excessive resuscitation or misjudgment of the disease condition, thereby providing a safer and more reliable practice framework for improving the clinical prognosis of trauma hemorrhagic shock patients. BRIEF DESCRIPTION OF DRAWINGS

[0016] Figure 1 A workflow diagram of the phased fluid resuscitation volume regulation method for a trauma hemorrhagic shock patient according to the present application; Figure 2 A structural diagram of the phased fluid resuscitation volume regulation system for a trauma hemorrhagic shock patient according to the present application. DETAILED DESCRIPTION

[0017] The technical solutions in the embodiments of the present application will be clearly and completely described below with reference to the drawings in the embodiments of the present application. Obviously, the described embodiments are only a part of the embodiments of the present application, rather than all the embodiments. Based on the embodiments in the present application, all other embodiments obtained by those skilled in the art without creative work fall within the scope of protection of the present application.

[0018] In this document, reference to“an embodiment” means that a particular feature, structure, or characteristic described in connection with the embodiment can be included in at least one embodiment of the application. The appearances of the phrase in various places in the specification are not necessarily all referring to the same embodiment, nor are they necessarily mutually exclusive of other embodiments. It is expressly understood that the described embodiments are merely examples from a whole set of possible embodiments that can be implemented and that those skilled in the art will be able to devise many embodiments that, although not explicitly described herein, embody the principles of the application and are included therein.

[0019] According to the first embodiment of the present application, the present application claims a phased fluid resuscitation volume regulation method for a trauma hemorrhagic shock patient, with reference to Figure 1 , comprising the following steps: S1, infusing crystalloid fluid to a patient to be regulated in an initial resuscitation stage, continuously monitoring mean arterial pressure and heart rate of the patient to be regulated, and determining that the initial resuscitation stage ends and enters an optimized resuscitation stage when the mean arterial pressure rises to a first predetermined threshold and the heart rate drops to a second predetermined threshold; S2, in the optimization resuscitation stage, the infusion rate is slowed down and the crystalloid is switched to colloid, and the central venous pressure and urine output of the patient to be controlled are monitored, the central venous pressure is maintained within a certain pressure range and the urine output is maintained within a certain flow range by adjusting the infusion rate of the colloid, and after a predetermined stabilization time, the stable monitoring stage is entered; S3, in the stable monitoring stage, the active liquid infusion is suspended, and the vital sign parameters of the patient to be controlled are monitored, if the mean arterial pressure and the central venous pressure of the patient to be controlled remain stable within a predetermined observation period, the volume responsiveness evaluation stage is entered, and if a downward trend occurs, the optimization resuscitation stage is returned to; S4, in the volume responsiveness evaluation stage, a passive leg-raising test is performed on the patient, and the heart rate and mean arterial pressure of the patient to be controlled are continuously monitored, if the mean arterial pressure rises by more than a predetermined change value and the heart rate falls by more than another predetermined change value after the passive leg-raising test, it is determined that the patient to be controlled has volume responsiveness, the optimization resuscitation stage is returned to for supplementary infusion, and if the changes do not reach the predetermined change values, it is determined that the patient has no volume responsiveness, the current liquid balance state is maintained, and the liquid resuscitation control is ended.

[0020] In this embodiment, at least one large-diameter venous access is established in the initial resuscitation stage, and normal temperature crystalloid is rapidly infused. During this process, the mean arterial pressure of the patient is continuously monitored using a non-invasive blood pressure monitor, and the heart rate of the patient is continuously monitored using an electrocardiogram monitor. When the mean arterial pressure is monitored to rise to a pre-set target pressure threshold level and the heart rate is monitored to fall to a pre-set target heart rate threshold level, it is determined that the target of the initial resuscitation stage has been reached, and the optimization resuscitation stage is immediately entered. In the optimization resuscitation stage, the crystalloid infusion rate is reduced and switched to colloid infusion. In this stage, a central venous catheter is inserted to monitor the central venous pressure, and a urinary catheter is indwelled in the patient to monitor the urine output per unit time. The infusion rate of the colloid is adjusted manually or by an infusion pump, and the specific adjustment logic is: when the central venous pressure reading is below a pre-set lower limit of the pressure range, the infusion rate is increased; when the central venous pressure reading approaches or reaches the upper limit of the pressure range, the infusion is reduced or suspended; at the same time, the urine output per unit time is maintained within a pre-set flow range; when the central venous pressure and the urine output are maintained within the above target range for a pre-set minimum time period, the stable monitoring stage is entered. All active fluid infusion is stopped during the stabilization monitoring phase, but the intravenous access is kept open; during this phase, the mean arterial pressure and central venous pressure of the patient are continuously monitored and recorded at fixed time intervals; a pre-set observation duration is observed, and if no clinically significant downward trend is observed in the mean arterial pressure and central venous pressure values measured during this observation duration, the patient enters the volume responsiveness assessment phase; if any parameter shows a sustained decrease and falls below its respective target threshold, the patient exits this phase and returns to the optimization resuscitation phase for fluid infusion; During the volume responsiveness assessment phase, the patient is changed from a supine position to a position with legs elevated, and this position is maintained for a pre-set time; the patient's heart rate and mean arterial pressure are continuously monitored before, during and after the change of position; if the mean arterial pressure increases by more than a pre-set change threshold during or after the legs-elevated position, and the heart rate decreases by more than another pre-set change threshold, the patient's volume responsiveness is determined to be positive, indicating that the volume needs to be continued to be supplemented, and the patient returns to the optimization resuscitation phase; if the above-mentioned parameter changes do not reach the pre-set threshold, the volume responsiveness is determined to be negative, and the current state is maintained, and the fluid resuscitation control process is ended.

[0021] Further, in the step S1, the arterial blood lactate level of the patient is also monitored synchronously while the crystalloid fluid is infused; When the mean arterial pressure and heart rate reach the first and second pre-determined thresholds, and the arterial blood lactate level starts to show a downward trend, it is determined that the initial resuscitation phase is ended.

[0022] In this embodiment, in the initial resuscitation phase, the arterial blood lactate level of the patient is also measured periodically by an arterial blood gas analyzer while the crystalloid fluid is infused; the determination condition for the end of the initial resuscitation phase is added: the mean arterial pressure and heart rate reach their respective target thresholds, and the latest measured arterial blood lactate level has shown a clear downward trend compared to the baseline value measured for the first time before resuscitation.

[0023] Further, in the step S2, the dynamic change of the arterial blood lactate level is also continuously tracked while the central venous pressure and urine output are monitored; In the optimization resuscitation phase, the arterial blood lactate level is ensured to continuously decrease below the safety threshold while the central venous pressure and urine output reach the specific range.

[0024] In this embodiment, in the optimization resuscitation stage, arterial blood lactate level is measured by arterial blood gas analysis at fixed time intervals while central venous pressure and urine output are regulated; the goals of this stage further include: ensuring that the arterial blood lactate levels measured in two consecutive times are both below a preset safety threshold while central venous pressure and urine output are stabilized in the target range, and then entering the stable monitoring stage.

[0025] Further, in the step S3, the vital signs parameters closely observed further include arterial blood lactate level; The criteria for determining that the vital signs remain stable further include that the arterial blood lactate level does not show a rebound phenomenon in the predetermined observation period.

[0026] In this embodiment, in the stable monitoring stage, the vital signs parameters that need to be monitored further include arterial blood lactate level; the criteria for determining that the vital signs remain stable are increased to: mean arterial pressure and central venous pressure remain stable in the predetermined observation period, and the arterial blood lactate level measured during this period does not show any rebound trend.

[0027] Further, in the step S4, if it is determined that the patient has no volume responsiveness, a heart function evaluation step is further started; The myocardial contractility of the patient is evaluated by clinical examination, and if it is found that the myocardial contractility is weakened, inotropic drugs are used for therapeutic intervention.

[0028] In this embodiment, in the volume responsiveness evaluation stage, if it is determined that the volume responsiveness of the patient is negative, a heart function evaluation sub-process is subsequently started; the sub-process includes evaluating jugular venous distension, listening for wet rales in the lungs, and visually evaluating the movement of the ventricular wall by a portable ultrasound device through physical examination to comprehensively judge the myocardial contractility; if the evaluation conclusion is that the myocardial contractility is weakened, inotropic drugs are administered through the intravenous route according to a predetermined drug regimen, and the hemodynamic state is re-evaluated without increasing fluid infusion.

[0029] Further, before the step S1, a pre-control step is further included: rapidly evaluating whether the patient has active bleeding; if it is confirmed that there is active bleeding, definitive hemostasis measures are immediately taken while fluid resuscitation is performed; the definitive hemostasis measures include surgery or interventional embolization.

[0030] In this embodiment, before starting the initial resuscitation phase, a pre-assessment and control step is performed: through physical examination to check for active bleeding points on the body surface, and through imaging examination to determine whether there is occult bleeding in the body cavity; once it is confirmed that there is an active bleeding source, the surgical team is immediately coordinated to perform surgical hemostasis or the interventional team is immediately coordinated to perform endovascular embolization hemostasis while starting fluid resuscitation; the goal of fluid resuscitation in this case is adjusted to maintain an acceptable minimum perfusion level before the completion of hemostasis measures.

[0031] Further, in the step S2, the colloidal solution is a hydroxyethyl starch solution or a gelatin solution; The specific way of adjusting the infusion rate of the colloidal solution is to speed up the infusion when the central venous pressure is lower than the lower limit of the specific pressure range, and to slow down or suspend the infusion when approaching or reaching the upper limit.

[0032] In this embodiment, in the optimal resuscitation phase, the colloidal solution used is a hydroxyethyl starch solution or a succinyl gelatin solution; the specific operation mode of adjusting the infusion rate of the colloidal solution is that the nursing staff manually rotates the infusion pump pulley to adjust the drop speed, or sets a new rate parameter on the infusion pump, to achieve fine control of the central venous pressure.

[0033] Further, in the steps S3 and S4, the patient's body temperature is monitored and maintained, the patient's core body temperature is maintained within the normal physiological range by warming the infusion equipment and the thermal blanket, and the accuracy of the hemodynamic parameters and the coagulation function are avoided to be affected by low body temperature.

[0034] In this embodiment, in the stable monitoring phase and the volume responsiveness assessment phase, the body temperature maintenance measures are simultaneously performed: all the infused liquids are preheated to near human core temperature by a liquid warming instrument, and an active inflatable thermal blanket is covered for the patient; the core temperature is continuously monitored by a temperature sensor attached to the skin, and the body temperature is maintained within a narrow normal physiological fluctuation range by the above measures, to ensure that the measurement of hemodynamic parameters is not disturbed by low body temperature.

[0035] Further, the method also includes a continuous bleeding and coagulation monitoring step during the entire execution process: Regularly check the patient's hemoglobin concentration and coagulation function indicators; If the hemoglobin concentration decreases progressively or the coagulation function is abnormal during fluid resuscitation, a warning signal is issued, indicating that there may be undetected continuous bleeding or coagulopathy, which needs to be re-evaluated and intervened; In the step S4, the operation standard of the passive leg raising test is: The patient is changed from a supine position to a position with the legs raised at a predetermined angle, the position is maintained for a predetermined time, and an ultrasound probe placed on the surface of the patient's body is used to monitor the change in femoral vein blood flow velocity throughout the process, and the increase in blood flow velocity is used as an additional index to assist in judging the volume responsiveness.

[0036] In this embodiment, a parallel bleeding and coagulation monitoring loop is performed throughout the entire process from the initial resuscitation stage to the end of the process: venous blood samples are taken from the patient at fixed time intervals, and laboratory analysis is performed to determine hemoglobin concentration and prothrombin time, activated partial thromboplastin time; if a progressive decrease in hemoglobin concentration or a significant prolongation of coagulation time is found, a warning is triggered, prompting the clinical team to immediately re-evaluate the patient's bleeding and coagulation status and prepare the corresponding blood products for infusion; During the passive leg-raising test in the volume responsiveness evaluation stage, an additional monitoring method is added: a blood flow probe of a portable Doppler ultrasound instrument is fixed to the surface projection position of the patient's femoral vein, and the blood flow spectrum of the femoral vein is continuously monitored; the peak blood flow velocity is recorded before and after the change in position; the percentage increase in peak blood flow velocity is used as an auxiliary judgment index, combined with the changes in heart rate and mean arterial pressure, to comprehensively determine the volume responsiveness of the patient.

[0037] According to the second embodiment of the present application, referring to Figure 2 The present application claims a phased liquid resuscitation volume control system for patients with traumatic hemorrhagic shock, comprising: One or more processors; A memory having one or more programs stored thereon, when the one or more programs are executed by the one or more processors, the one or more processors implement the method for phased liquid resuscitation volume control for patients with traumatic hemorrhagic shock.

[0038] The following is described with specific embodiments: Patient positioning and preliminary assessment: the patient is translated to the rescue unit of the intensive care unit, immediately taken to the supine position without a pillow, and the primary assessment is quickly performed by the attending physician, including checking the consciousness, airway patency, and skin and mucous membrane color, and confirming the presence of typical manifestations of tissue perfusion deficiency; at the same time, a nurse quickly prepares the required equipment and liquid; Specific operation of venous access establishment: the median cubital vein or basilic vein of the upper limb is selected as the puncture point, if the peripheral vascular condition is not good, the internal jugular vein or femoral vein is immediately prepared for central venous puncture; after skin disinfection, a large-size venous indwelling needle is used for puncture, after smooth backflow is seen, the needle handle is fixed, and the pre-prepared infusion pipeline with a flow regulating valve is connected; to ensure rapid infusion, two or more venous access can be considered to be established at the same time.

[0039] Liquid infusion and initial monitoring start, the nurse completely open the flow regulating valve, so that the liquid infusion at the maximum natural gravity speed; another nurse at the same time, the non-invasive blood pressure cuff on the patient's healthy upper limb, set monitoring mode for high-frequency interval measurement; ECG monitor electrode pieces were accurately placed on the patient's chest, continuously display ECG waveform and calculate heart rate value; all monitoring data are displayed in real time on the central monitoring screen.

[0040] The target achievement determination process, the attending physician closely monitors the monitoring screen, observes the dynamic trend of mean arterial pressure and heart rate; when the mean arterial pressure curve starts to steadily rise from a low state and eventually reaches the preset target pressure threshold line, and the heart rate value continuously decreases from a high level to the preset target heart rate threshold line, the physician will ask the nurse to report the latest three measurement values to confirm the stability of the trend; after confirming that both meet the standards and the trend is stable, the physician issues an oral instruction: "initial resuscitation target achieved, stop rapid infusion, prepare to enter the optimization resuscitation phase".

[0041] Optimization resuscitation phase execution treatment conversion and advanced monitoring establishment, the nurse quickly replaces the crystal liquid being infused with colloidal liquid, and significantly reduces the infusion rate from high speed to a moderate maintenance rate; at the same time, the physician completes the central venous catheterization under strict sterile operation, the catheter end is connected to the pressure sensor, and after zero calibration, the central venous pressure waveform and value are continuously displayed; another nurse disinfects the patient's urethral orifice and inserts a sterile urinary catheter connected to a urine bag with a measurement mark to start recording hourly urine output.

[0042] Fine management of volume control, the nurse responsible for bedside is given clear instructions to closely observe the central venous pressure reading; if the reading is continuously below the lower limit of the target range, slowly rotate the infusion pulley clockwise to appropriately increase the drop speed, and closely observe the pressure change; if the reading rises close to or reaches the upper limit of the target range, immediately rotate the pulley counterclockwise to reduce the drop speed, or even temporarily close the pipeline to observe whether the pressure will fall; at the same time, record the hourly urine output to ensure it is between the preset minimum and maximum flow rates; throughout the process, the nurse needs to report vital signs and fluid balance to the physician at regular intervals.

[0043] Confirmation of phase progression, when the central venous pressure and urine output are maintained within the target range for a preset continuous period of time, and the infusion rate does not need to be frequently adjusted during this period, the physician assesses that the volume status has reached an optimal balance, and directs to enter the stable monitoring phase.

[0044] The stabilization monitoring phase is a period of passive observation, during which no additional fluid is actively infused to expand volume, except to keep the intravenous line patent. The monitor continues to record mean arterial pressure and central venous pressure at regular intervals. The nurse marks each measurement on a specially designed flow sheet, and connects the marks to form a trend graph.

[0045] The stability assessment and decision phase is a period during which the physician periodically reviews the trend graph. The focus is to assess whether there is a persistent, clinically significant decrease in the parameter of interest; for example, whether the mean arterial pressure is trending downward over several consecutive measurements, rather than just fluctuating around a value. If the trend is completely flat, the plan is to proceed to the next phase. If there is a clear downward trend, the decision is that the volume is not yet stable, and the order is given to restart the colloid infusion regimen of the optimization resuscitation phase.

[0046] The volume responsiveness assessment phase is a period during which the passive leg-raising test is performed. After a brief explanation of the purpose of the test to the patient or family, two healthcare workers collaborate: one stands at the foot of the patient's bed, and holds the patient's feet and lower legs, while the other holds the patient's thighs and hips. On a command, both workers raise the patient's lower limbs to a specified angle, and support the position with soft pads. Throughout the procedure, the patient's torso is kept in contact with the bed, and only the lower limbs are moved; The hemodynamic response is captured and interpreted. Before the leg-raising, a baseline heart rate and mean arterial pressure are recorded. During the leg-raising, and after the leg is lowered, the physician closely watches the monitor screen for changes in these two parameters. The focus is to observe whether, after the leg-raising, there is a rapid increase in mean arterial pressure that exceeds a pre-specified threshold, accompanied by a corresponding decrease in heart rate that exceeds another threshold. This positive response is taken as a sign of increased cardiac preload leading to increased cardiac output, and is an indication that the patient can still benefit from further fluid resuscitation. If there is no such change, it is an indication that the cardiac function is at a plateau, and further fluid resuscitation will be ineffective.

[0047] The initial resuscitation phase includes lactate monitoring. While the crystalloid fluid is being rapidly infused, the nurse periodically draws blood samples from the patient's arterial or venous line (if an arterial line is already in place), and immediately sends the samples to a blood gas analyzer for testing. The arterial blood lactate level from the test report is recorded. The physician, in judging that the mean arterial pressure and heart rate have met the criteria, also compares the current lactate value with the baseline value before resuscitation. Only when the lactate level exhibits a clear, consistent downward trend (e.g., the second measurement is lower than the first) is the goal of the initial resuscitation phase finally confirmed. This avoids the possibility that a persistent tissue hypoxia is masked by the recovery of pressure indicators alone.

[0048] In the optimized resuscitation phase, lactate targets are increased. In addition to regulating central venous pressure and urine output, nurses will still draw blood samples at fixed intervals (such as every half hour or one hour) to monitor arterial blood lactate. The goals of this stage become three-dimensional: central venous pressure stabilizes within the target range, urine output meets the target, and arterial blood lactate levels measured twice consecutively drop below the preset safety threshold. Only when these three conditions are met simultaneously and maintained for the required minimum time period can the stable monitoring phase begin.

[0049] This ensures that while optimizing capacity, the oxygen debt of cells is also fundamentally corrected.

[0050] Lactate monitoring was added during the stable monitoring phase. During the observation period of the stable monitoring phase, monitoring of arterial blood lactate continued. The criteria for determining "stability" have become more stringent, requiring not only that the mean arterial pressure and central venous pressure show no significant downward trend, but also that the arterial blood lactate level measured during this period remains stable or continues to decline slowly, with absolutely no meaningful rebound. If lactate levels rise, even if blood pressure and central venous pressure are temporarily stable, it is considered an early warning sign of deteriorating tissue perfusion, requiring immediate return to the optimized resuscitation phase for intervention.

[0051] After a negative volume responsiveness test, cardiac function assessment is added. The procedure does not end immediately when the passive leg raise test shows a negative volume responsiveness. The physician will then initiate a systematic cardiac function assessment sub-process, starting with a physical examination: Slowly raise the head of the patient's bed and observe for jugular vein distension in the neck; carefully auscultate the bases of both lungs with a stethoscope to check for moist rales (indicating pulmonary edema); then, use a portable ultrasound device to place the probe in the precordial region to quickly assess the range of motion and coordination of the walls of each ventricle. If a generalized decrease in ventricular wall motion or segmental motion abnormalities are found, combined with jugular venous distension or pulmonary rales, the primary diagnosis is impaired myocardial contractility. In this case, the treatment focus shifts to cardiotonics rather than volume expansion, meaning that cardiotonics are administered intravenously according to the pre-determined medication regimen, and hemodynamic parameters are monitored again.

[0052] Increasing pre-treatment bleeding control steps: After contacting the patient and initially determining that they are in traumatic hemorrhagic shock, the medical team will prioritize a rapid but comprehensive bleeding source identification procedure before any fluid resuscitation begins.

[0053] This includes: carefully checking the whole body surface for visible active bleeding wounds, and focusing on palpation and visual inspection of all blunt or penetrating wound areas, while immediately initiating bedside ultrasound machine to perform focused abdominal trauma assessment (FAST scan) to explore the presence of free fluid (hematocele) in abdominal cavity, pericardial cavity, etc. Once a clear or highly suspicious active bleeding source is found, the resuscitation strategy is immediately adjusted, while quickly establishing intravenous access, the highest priority work becomes to urgently contact the surgical or interventional team for hemostasis (such as surgery or vascular embolization); At this time, the goal of fluid resuscitation is set to "damage control resuscitation", that is, only a small amount of fluid is infused to maintain the mean arterial pressure at a minimum level that can ensure the basic perfusion of important organs, avoiding the dislodgement of thrombus formed due to rapid blood pressure rise, and aggravating bleeding.

[0054] The type and adjustment method of colloid solution are clear, and the selected colloid solution is specifically specified as two commonly used types in the optimization resuscitation stage: Hydroxyethyl starch solution or succinyl gelatin solution, and one is selected according to the routine drug preparation of the hospital pharmacy.

[0055] Regarding the adjustment of infusion rate, two clinically common methods are adopted: One is that the nurse directly manually rotates the pulley on the infusion device to control the drop speed according to the reading of central venous pressure, and estimates the flow rate by observing the drop speed in the drip bottle with naked eyes; the other more accurate way is to use an intelligent infusion pump, and the nurse presets the target range of central venous pressure into the pump, or directly inputs a new milliliter per hour rate parameter into the pump according to the doctor's instruction, which is automatically and accurately executed by the pump.

[0056] Increase the body temperature maintenance measures, since low body temperature can seriously affect the coagulation function and drug metabolism of shock patients, active body temperature maintenance measures are simultaneously performed from the stable monitoring stage to the volume responsiveness evaluation stage.

[0057] All the prepared infusion liquids (including the subsequent possible drug carriers) need to be preheated by a special liquid warming instrument to make their temperature close to the human core temperature.

[0058] At the same time, the patient is covered with an active inflatable warming blanket, and warm air in the blanket circulates on the patient's body surface; A body temperature sensor is attached to the patient's skin (such as under the armpit or forehead) to continuously monitor the body surface temperature as a reference for core temperature; Through these comprehensive measures, the patient's body temperature is maintained within a narrow normal physiological range, ensuring that the monitored hemodynamic parameters truly reflect the volume status rather than the false appearance of low temperature interference.

[0059] Increased bleeding and coagulation monitoring loops, parallel to the above four phases, throughout the entire monitoring loop; From the initial resuscitation phase, the nurse will draw venous blood samples from the patient at regular intervals (e.g. every hour), label them clearly and rush them to the laboratory for testing; The key laboratory tests include hemoglobin concentration (to reflect whether there is progressive bleeding leading to blood dilution) and prothrombin time, activated partial thromboplastin time (to reflect whether there is a coagulation disorder); These results will be reported to the attending physician in a timely manner, and if a progressive decrease in hemoglobin concentration or a significant prolongation of coagulation time beyond the normal range is found, an early warning will be triggered. The physician will then re-evaluate the patient's bleeding and coagulation status comprehensively and prepare the corresponding blood products (such as red blood cell suspension, fresh frozen plasma, etc.) in advance to perform component transfusion at any time to correct the coagulopathy.

[0060] Passive leg raising test with increased Doppler ultrasound monitoring, during the standard passive leg raising test, an objective auxiliary monitoring method is added; A trained physician or sonographer will place the blood flow probe of a portable Doppler ultrasound device, coated with coupling agent, stably on the surface projection of the patient's femoral artery in the groin area (Note: The femoral vein mentioned in the claims is usually deeper and has weaker signals, so the femoral artery is more commonly monitored as a substitute in clinical practice).

[0061] After the probe is fixed, the screen continuously displays the spectral waveform of blood flow. Before the leg is raised, a baseline peak blood flow velocity is recorded. During the leg raising period, the peak velocity is recorded again, and the percentage increase in peak velocity after leg raising relative to the baseline value is calculated. This percentage change is used as an auxiliary, quantitative judgment indicator. Finally, the physician combines the decrease in heart rate, the increase in mean arterial pressure, and the percentage increase in peak femoral artery blood flow velocity to make a comprehensive judgment, thereby more accurately determining the patient's volume responsiveness and reducing the possibility of misjudgment by a single indicator.

[0062] In the several embodiments provided in this application, it should be understood that the disclosed system, apparatus, and method can be implemented in other ways. For example, the apparatus embodiments described above are merely illustrative. For example, the division of units is only a logical functional division. In actual implementation, another division manner can be used, for example, a plurality of units or components can be combined or integrated into another system, or some features can be omitted or not executed. In addition, the coupling or direct coupling or communication connection between the units or components shown or discussed can be indirect coupling or communication connection through some interfaces, apparatuses or units, and can be electrical, mechanical or other forms.

[0063] In addition, the various functional units in the embodiments of the present application can be integrated in one processing unit, or each can exist as an independent physical unit, or two or more than two of them can be integrated in one physical unit. The above-mentioned integrated unit can be implemented in the form of hardware, or in the form of a software functional unit. The above is only an embodiment of the present application, and does not limit the patent scope of the present application, and any equivalent structure or equivalent process transformation using the content of the present application specification and drawings, or direct or indirect application in other related technical fields, are also included in the patent protection scope of the present application.

[0064] The specific embodiments of the application are described in detail above, but they are only examples. The present application is not limited to the above-described specific embodiments. Any equivalent modification or substitution of the present application made by those skilled in the art is also within the scope of the present application, and therefore, equivalent transformation and modification, improvement, etc. made without departing from the spirit and principle range of the present application should be included in the scope of the present application.

Claims

1. A method for phased fluid resuscitation and volume regulation in patients with traumatic hemorrhagic shock, characterized in that, Includes the following steps: S1, In the initial resuscitation phase, crystalloid fluid is infused into the patient to be controlled, and the mean arterial pressure and heart rate of the patient to be controlled are continuously monitored. When the mean arterial pressure rises to a first predetermined threshold and the heart rate drops to a second predetermined threshold, the initial resuscitation phase is determined to end and the optimized resuscitation phase is entered. S2, during the optimized resuscitation phase, the infusion rate is slowed down and switched to colloid infusion. At the same time, the central venous pressure and urine output of the patient to be controlled are monitored. By adjusting the infusion rate of the colloid, the central venous pressure is maintained within a specific pressure range and the urine output is maintained within a specific flow range. After a predetermined stabilization time, the stabilization monitoring phase begins. S3, during the stable monitoring phase, active fluid infusion is paused, and the vital signs parameters of the patient to be controlled are monitored. If the mean arterial pressure and central venous pressure of the patient to be controlled remain stable within the predetermined observation period, the volume responsiveness assessment phase is entered. If a downward trend is observed, the patient returns to the optimized resuscitation phase. S4, During the volume responsiveness assessment phase, a passive leg raise test is performed on the patient, while continuously monitoring changes in the patient's heart rate and mean arterial pressure. If, after the passive leg raise test, the increase in mean arterial pressure exceeds a predetermined value and the decrease in heart rate exceeds another predetermined value, the patient is determined to have volume responsiveness, and the patient returns to the optimized resuscitation phase for supplemental fluid infusion. If the changes do not reach the predetermined values, the patient is determined to have no volume responsiveness, the current fluid balance is maintained, and the current fluid resuscitation intervention ends.

2. The method for phased fluid resuscitation and volume control in patients with traumatic hemorrhagic shock according to claim 1, characterized in that, In step S1, the patient's arterial blood lactate level is monitored simultaneously while the crystalloid solution is being infused. The initial resuscitation phase is considered complete when the mean arterial pressure and heart rate reach the first and second predetermined thresholds, and the arterial blood lactate level begins to show a downward trend.

3. The method for phased fluid resuscitation and volume control in patients with traumatic hemorrhagic shock according to claim 2, characterized in that, In step S2, while monitoring central venous pressure and urine output, the dynamic changes in arterial blood lactate levels are also continuously tracked. During the optimized resuscitation phase, while ensuring that central venous pressure and urine output reach the specified ranges, arterial blood lactate levels continue to decrease to below a safe threshold.

4. The method for phased fluid resuscitation and volume control in patients with traumatic hemorrhagic shock according to claim 3, characterized in that, In step S3, the vital signs parameters that are closely monitored also include arterial blood lactate levels; Criteria for determining that vital signs remain stable also include that arterial blood lactate levels do not rise during the predetermined observation period.

5. The method for phased fluid resuscitation and volume control in patients with traumatic hemorrhagic shock according to claim 1, characterized in that, In step S4, if it is determined that the patient has no volume responsiveness, then the cardiac function assessment step is further initiated. The patient's myocardial contractility is assessed through clinical examination. If weakened myocardial contractility is found, cardiotonic drugs are used for treatment intervention.

6. The method for phased fluid resuscitation and volume control in patients with traumatic hemorrhagic shock according to claim 1, characterized in that, Prior to step S1, a pre-control step is included: a rapid assessment of whether the patient has active bleeding; if active bleeding is confirmed, definitive hemostasis is immediately implemented while fluid resuscitation is being performed; the definitive hemostasis includes surgical intervention or interventional embolization.

7. The method for phased fluid resuscitation and volume control in patients with traumatic hemorrhagic shock according to claim 1, characterized in that, In step S2, the colloidal solution is a hydroxyethyl starch solution or a gelatin solution; The specific method for adjusting the infusion rate of the colloid solution is to accelerate the infusion when the central venous pressure is below the lower limit of the specific pressure range, and slow down or stop the infusion when it approaches or reaches the upper limit.

8. The method for phased fluid resuscitation and volume control in patients with traumatic hemorrhagic shock according to claim 1, characterized in that, In steps S3 and S4, the patient's body temperature is monitored and maintained simultaneously. The patient's core body temperature is kept within the normal physiological range by using a warming infusion device and a warming blanket to avoid hypothermia affecting the accuracy of hemodynamic parameters and coagulation function.

9. A method for phased fluid resuscitation and volume control in patients with traumatic hemorrhagic shock according to claim 1, characterized in that, The method also includes continuous bleeding and coagulation monitoring throughout the entire process: Regularly check the patient's hemoglobin concentration and coagulation function indicators; If a progressive decrease in hemoglobin concentration or coagulation dysfunction occurs during fluid resuscitation, an early warning signal will be issued, indicating that there may be undetected persistent bleeding or coagulation dysfunction, requiring reassessment and intervention. In step S4, the operating standard for the passive leg-raising test is as follows: The patient was changed from a supine position to a position with both legs raised at a predetermined angle, and this position was maintained for a predetermined time. Throughout the process, an ultrasound probe placed on the patient's body surface was used to monitor changes in femoral vein blood flow velocity, and the increase in blood flow velocity was used as an additional indicator to help determine volume responsiveness.

10. A phased fluid resuscitation volume regulation system for patients with traumatic hemorrhagic shock, characterized in that, include: One or more processors; A memory having stored one or more programs that, when executed by one or more processors, cause the one or more processors to implement a phased fluid resuscitation volume control method for patients with traumatic hemorrhagic shock according to any one of claims 1 to 9.

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