多发伤一期手术处理(附168例病例分析)

PRIMARY OPERATIVE MANAGEMENT IN MULTIPLE TRAUMAS-ANALYSIS OF 168 CASES

目的：从168例多发伤的处理方法、流行病学、创伤指数、并发症及病死率的总结分析，说明多发伤一期手术处理在急诊科的地位。方法；急诊科直接收治多发伤首诊病人，遇有多发伤合并休克，立即抗休克治疗，做好术前准备，反复体检、观察和评估。手术时，如脑胸腹四肢联合伤，一般分两组进行手术。结果：168例共406处伤，手术处理共246例次。总死亡率7．7％，发生两个脏器功能衰竭16例，死亡4例，占25％，三个脏器功能衰竭8例，死亡6例，占75％。平均住院无数：一期手术处理为1．5±6．4，分期为24±4．4（两者有显著差异）。结论：多发伤一期手术处理，在相同创伤指数下，可减少术后并发症，降低死亡率和病残率；缩短住院时间；简化手续，为多发伤病人的抢救赢得MSOF时间，证明多发伤一期手术处理在急诊科中的重要性和必要性。

The role of primary operative intervention in the management of multiple traumas was studied byanalyaing the epidemiology, trauma index, methods of treatment, complications and the mortality rate of 168 casesadmitted to our hospital. These patients were first seen by doctors of the emegency department and anti-shock mea-sures given immediately, others included complete physical examination, closed observation, evaluation and preoper-ative preparation. If there were brain, thorax, abdomen or fractures coexisting, two operation teams should attendthe surgery simultaneously Results: Totally 246 operative times were performed at 406 trauma sites in 168 cases,with a mortality of 7. 7N. multiple system organ failure developed in 24 cases of which two organ functional failurein 16 cases, 4 cases dided and three organ functional failure in 8 cases, 6 cases died. The average time of hospitalstay in primary operation group is 15 ± 6. 4 days, less than that in staged operation group 24 ± 4. 4 days (P<0. 01). Conc1usion: primary operative management with similar trauma index can reduce the complicatiofl, mortalityand morbility rates and shorten the time of hospital stay. We conclude that primary operative intervention plays animportant role in the management of multiple traumas.