Objective To analyze the effects of fluid resuscitation mode guided by the variation of inferior vena cava based on B-ultrasound on thrombus elasmogram and inflammatory factors in patients with traumatic hemorrhagic shock, and explore the relationship between different fluid resuscitation modes and the prognosis of patients. Methods A total of 104 patients with traumatic hemorrhagic shock admitted to our hospital from January 2020 to June 2022 were selected and divided into control group (52 cases) and observation group (52 cases) according to random number table method. The control group received conventional limited fluid resuscitation, and the observation group received fluid resuscitation guided by B-ultrasound of inferior vena cava variation. The differences of clinical data, thromboelastogram indexes ［coagulation reaction time (R), blood clot formation time (K), maximum clot intensity］, inflammatory factors ［tumor necrosis factor α (TNF-α), interleukin-6 (IL-6), and IL-10］ between the two groups were compared. According to the occurrence of death, multiple organ dysfunction syndrome and acute respiratory distress syndrome within 28 days, 104 patients were divided into poor prognosis group (23 cases) and good prognosis group (81 cases). The factors affecting prognosis were analyzed by binary logistics regression to explore the relationship between different fluid resuscitate modes and prognosis. Results Compared with the control group, the amount of infusion, blood transfusion and ICU stay in the observation group were less (P＜0.05). Compared with the control group, R and K were lower and the maximum blood clot intensity was higher in the observation group at 1 h (P＜0.05). Compared with the control group, the TNF-α, IL-6 and IL-10 in the observation group were lower at 1 h after intervention (P＜0.05). Compared with the good prognosis group, the time from onset to admission was ≥6 h, the proportion of restricted fluid resuscitation, the shock index and ISS score were higher in the poor prognosis group (P＜0.05). Time from onset to admission (＜6 h=1, ≥6 h=0), fluid resuscitation mode (guidance for inferior vena cava variation =1, restricted fluid resuscitation =0), shock index and ISS score were independent variables, and prognosis (poor prognosis =1, good prognosis =0) were dependent variables. Dualistic logistics regression analysis showed that fluid resuscitation mode, time from onset to hospital admission and ISS score were the factors influencing poor prognosis (P＜0.05). Conclusion Guided fluid resuscitation based on B-ultrasound for inferior vena cava variation can improve patient rehabilitation and treatment efficiency, improve thromboelastography and inflammatory response, and is a protective factor for poor prognosis of patients