Objective  To explore the clinical efficacy of routine fluid resuscitation (RFR), limited fluid resuscitation (LFR), and hypertonic fluid resuscitation (HFR) combined with therapeutic hypothermia (TH) in treating patients with traumatic hemorrhagic shock (THS).

Methods  Patients with THS admitted to the Department of Emergency, Wenzhou People's Hospital from June 1st, 2020, to June 1st, 2023, were retrospectively included. All THS patients were treated with fluid resuscitation combined with TH. According to different fluid resuscitation regimens, they were divided into the RFR group, the LFR group, and the HFR group. Outcomes were compared among groups, including 24-hour mortality rate, 7-day mortality rate, incidence of complications, coagulation function [thrombin time (TT), activated partial thromboplastin time (APTT), fibrinogen (FIB), and prothrombin time (PT)], liver and kidney function [aspartate aminotransferase (AST), alanine aminotransferase (ALT), serum creatinine (Scr), and blood urea nitrogen (BUN)], electrolyte levels (potassium, sodium, chloride, and magnesium), changes in lactate concentration, and inflammatory markers in peripheral blood [interleukin (IL)-10, IL-4, IL-6, and tumor necrosis factor-alpha (TNF-α)].

Results  A total of 264 patients were included, with 67 cases in the RFR group, 119 in the LFR group, and 78 in the HFR group. After propensity score matching (PSM), each group consisted of 67 patients. The 24-hour mortality rates of the RFR group, the LFR group, and the HFR group had no statistical difference (4.48% vs. 4.48% vs. 4.48%, P>0.05). The 7-day mortality rates of the LFR group (10.45% vs. 29.85%, P<0.05) and the HFR group (4.48% vs. 29.85%, P<0.05) were significantly lower than that of the RFR group, but there was no significant difference in 7-day mortality rates between the LFR group and the HFR group (10.45%  vs. 4.48%, P>0.05). The incidences of disseminated intravascular coagulation (DIC) in the LFR group(4.48% vs. 19.40%, P<0.05) and the HFR group (4.48% vs. 19.40%, P<0.05) were significantly lower than that in the RFR group, and there were no statistically significant differences among the three groups in the incidence of other complications, including acute renal failure, acute respiratory distress syndrome, and multiple organ dysfunction syndrome (P>0.05). One hour after resuscitation, the levels of TT, APTT, PT, AST, ALT, BUN, serum potassium, serum sodium, serum chloride, serum magnesium, and lactate in the LFR group and the HFR group were lower than those in the RFR group (P<0.05), while the level of FIB was higher than that in the RFR group (P<0.05). In addition, the levels of IL-10 and IL-4 in the LFR group and the HFR group were significantly higher than that in the RFR group (P<0.05), while the levels of IL-6 and TNF-α were significantly lower than those in the RFR group (P<0.05).

Conclusion  Compared with RFR, both LFR and HFR combined with TH can improve the levels of coagulation function, electrolytes, lactic acid, and inflammatory factors in THS patients to some extent, and reduce the mortality rate and the occurrence of DIC in THS patients.

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