胸腹联合伤的AIS-ISS评分及外科治疗

Clinical features and surgical management of thoracoabdominal multiple injuries

目的总结胸腹联合伤创伤评分与临床诊断和治疗方法的关系,旨在提高该病的诊断及治疗水平。方法回顾分析83例胸腹联合伤患者临床资料,并对其进行简明创伤分级(AIS)及损伤严重程度评分(ISS)。其中交通事故伤38例,刀刺伤24例,坠落伤8例,挤压伤8例,重物砸伤5例。患者手术治疗43例,胸腔闭式引流28例,保守治疗12例。结果治愈73例,死亡10例,死亡率12.1%。结论详细询问病史及查体,胸、腹部X平片,CT、胸腹部B超、消化道钡剂造影及钡灌肠造影检查有助胸腹联合伤的诊断。对诊断明确的胸腹合并伤,首先改善呼吸功能,恢复有效循环量,对ISS评分大于26的患者,应积极做好手术准备。

Objective To summarize the clinical features and surgical management of thoracoabdominal multiple injuries （TAMI） so as to improve the diagnoses and treatments of the disease. Methods A retrospective study was carried out on 83 cases of TAMI treated surgically. There were 38 cases of traffic accidents, 24 cases of penetrating injuries, 8 cases of falling injuries, 8 cases of extrusion injuries and 5cases of blunt traumas. All the cases were graded with injury severity scale （1SS）. Forty - three cases received thoracotomy and/or laparotomy, 28 eases received close drainage of thoracic cavity and 12 cases receiving conservative treatment, respectively. Result Ten cases were dead from hemorrhagic shock （6 cases ） , multiple organ failure （3 cases ） , and cardiac arrest. The remaining 73 cases were cured. Conclusion TAMI has a high mortality rate. It is necessary to perform all -round examination and it is helpful to use x - ray, CT and ultrasonic examination. To the TAMI, the key step is to improve the cardiopulmunary physiology. If the ISS scale is more than 26, the patients should be prepared for surgical treatment actively.