严重创伤病人ICU治疗期间再手术探讨

Re-operation of patient with severe trauma in intensive care unit

目的探讨严重创伤病人ICU治疗期间的再手术治疗。方法2000年1月～2006年12月对76例严重创伤病人在ICU治疗期间行再次手术治疗，其中58例为多发伤，ISS〉16分16例，≥25分42例；18例为单发伤，AIS评分均〉3分。所有患者均接受了早期急诊手术，其中43例早期行确定性手术，33例因伤情特别危重而行损害控制手术。在ICU治疗期间行损害控制手术的病人根据情况行确定性手术，40例常规手术的病人发生应激性溃疡、肠瘘、胸腹腔脓肿、胆囊坏疽、出血等继发性病变而行再次手术治疗。结果59例救治成功，救治成功率达77．6％；17例死亡，早期死亡主要原因为原发性损伤过重直接导致呼吸循环衰竭，后期主要死于多脏器功能衰竭。结论严重创伤病人在ICU治疗期间应密切观察病情变化，及时诊断需要手术解决的继发性病变，一旦确定应及时手术治疗；行损害控制手术的病人需进一步完善诊断，尽量在48小时内行确定性手术，对全身情况不稳定、伤情复杂的病人，宜行分期多次手术。

Objective To explore re-operation of the patient with severe trauma in intensive care unit （ ICU ）. Methods Seventy-six patients with severe trauma received re-operation in ICU from January 2000 to December 2006, among which 58 cases were multiple trauma （ ISS 〉 16 in 16 cases, ISS ≥ 25 in 42 cases ） , 1 g cases were single trauma（ AIS 〉 3 ）. All the patients received early operation,in which 43 cases underwent the definitive operation ,33 cases received damage control operation because of too severe injury. During the intensive care ,40 patients who received routine operation, underwent re-operation because of stress ulcer; intestinal fistula, abscess of pleural cavity or intraperitoneal abscess, gangrene of gallbladder and hemorrhage. Results Fifty-nine patients were cured （77.6% ） , 17 patients died. The main causes of early death were respiratory and circulatory failure because of severe injury,and the late death causes were multiple organ failure. Conclusion The patients with severe trauma should be observed intensively in intensive care unit, diagnosed and operated promptly to solve secondary pathological changes. The perfect diagnosis is needed. The definitive operation should be taken as soon as possible within 48 hours after injury. The staging operation should be taken in the patients with unstable vital signs.