损伤控制性手术在严重腹部损伤的应用

Application of damage control operation on serious abdominal trauma

目的通过对严重腹部损伤患者实施损伤控制策略和方法,探索在救治严重腹部损伤的新途径,提高创伤的抢救成功率。方法在对128例腹部损伤患者进行初步急救处理后,按照ISS创伤评分,分成一般损伤组(ISS评分≤16,一期确定性手术)和严重损伤组(ISS>16,分期手术)。参照“致死三联症”监测指标,选择酸碱度(pH)、凝血酶原(PT)、体温(T)、氧饱和度(SO2),两组进行比较。同时对两组腹部手术后并发症进行比较。结果128例腹部损伤患者均进行了剖腹探查术,对进入复苏期的一般损伤组和严重损伤组的pH、PT、T和SO2监测指标进行比较,差异无显著性(P>0.05);两组术后腹部并发症比较,差异无显著性(P>0.05)。结论经过损伤控制性手术救治的严重损伤组,在复苏期的四项指标与一般损伤组差异无显著性,复苏过程平稳,腹部并发症亦可得到有效控制。

[Objective] To search new treatment approach in order to increase the cure rate by the application of damage control strategy and methods on the patient with serious abdominal trauma. [Methods] According to the ISS wound grade, 128 patients with abdominal trauma, after being carried on the initial first-aid treatment, were divided into general injury group （ISS≤ 16, primary definitive operation） and serious injury group （ISS〉16, planned reoperation）. Referred to the monitor target of ＂triple-associate lethiferous syndrome＂, made a comparison between the two groups by pH, prothrombin time（PT）, temperature （T）, oxygenated hemoglobin saturations （SO2）, as well as, complications of laparotomy. [Results] All patients underwent damage control laparotomy and came into resuscitation phase, PH, PT, T and SO. of the two groups, as well as complications of laparotomy, were exercised t-test and chisquare test without statistical difference （P 〉0.05）. [Conclusions] The serious group that undergo damagecontrol laparotomy have no statistical difference with general group at four index signs at resuscitation phase, resuscitative protess is steady, the complications of laparotomy get the valid control also.