413例严重多发伤的救治体会

Management of 413 patients with severe multiple trauma

目的探讨严重多发伤的临床特点及救治措施。方法对1999年9月～2006年3月救治的413例严重多发伤进行回顾性分析。结果本组病例的临床诊断均符合多发伤标准,创伤严重度评分(ISS)>16,平均23.5±8.2。急诊手术322例次,其中64例在1次麻醉下分组同台完成了2个以上部位的手术。重症监护病房(ICU)平均住院(21.8±5.6)天。临床治愈289例(70%),致残67例(16.2%),死亡57例(13.8%)。结论诊断性胸腹腔穿刺和床旁B超检查快速、简洁、敏感。病情允许的伤者可考虑头、胸、腹同时CT扫描。手术顺序应按其致命性严重程度决定,尽可能在一次麻醉下分组同台处理不同部位的损伤。主动实施损伤控制性手术(DCO)策略,术后均进入ICU,可有效降低病死率。

Objective To discuss clinical diagnosis and treatment of severe multiple trauma. Methods The clinical data of severe multiple trauma in 413 cases from Sept. 1999～Mar. 2006 admitted in our hospital were analysed. Results A total of 413 patitnts sustaining severe multiple trauma, Injury Severity Score （ISS） 〉 16 （23.5±8.2 ）. 322 patients underwent immediate emergent operations. Among them 64 patients received two or three operations on different anatomical regions under a single anesthesia. Mean length of stay in the intensive care unit （ICU） was（ 21.8±5.6） days. 289 cases（70%） had a good recovery ,67 cases（ 16.2% ） disabled and 57 cases （ 13.8% ） died. Conclusion Certain injuries are so critical that the history collection,the emergent physical ex-amination and definitive resuscitation must be undertaken at the same time. Diagnostic thoracico-abdominal para-centesis and ultrasound study are rapid and accurate method for the diagnosis of thoracico and abdominal injury. CT is non-invasive,sensitive,and accurate for the evaluation of head injury,thoracic injury and abdominal injury in he- modynamically stable patients, and missed diagnosis should be reduced as much as possible. The operation se-quence should be depended on the importance and the injury severity of the involved organ. The operations on dif-ferent anatomical regions should be done as far as possible under a single anesthesia. Damage control operation （DCO） should precede definitive reconstruction. All postoperative patients should enter the ICU.