严重多发伤并发症的早期控制

Early management of complication on severe multiple trauma

目的探讨损伤控制理论对严重多发伤并发症早期控制的临床效果。方法回顾性分析2006年1月至2008年1月武汉市同济医院收治的116例严重多发伤患者，依据救治方式分为损伤控制组（55例）和常规方式组（61例），对两组患者的手术持续时间、术后休克和“致死性三联征（LTD）”的纠正情况、术后并发症和预后情况进行统计学分析，比较损伤控制手术和常规确定性手术对严重多发伤患者并发症的早期控制情况。结果采用两种不同救治方式后，损伤控制组手术持续时间为（67．43±19．52）min，休克和“致死性三联征”纠正时间分别为（6．77±3．16）h和（11．54±4．10）h，常规方式组手术持续时间为（163．95±55．41）min，休克和“致死性三联征”纠正时间分别为（22．51±11．65）h和（34．55±5．63）h，两组间差异具有统计学意义（19〈0．01）；损伤控制组并发症人均发生率和病死率分别为227．27％和3．64％，常规方式组并发症人均发生率和病死率分别为363．93％和9．84％，差异具有统计学意义（P〈0．05）。结论在严重多发伤救治中早期应用损伤控制理论能显著缩短手术时间，早期纠正休克和LTD，减少术后并发症的发生，降低病死率。

Objective To analyze the efficacy of early management of complications in patients with multiple traumas by applying the damage control theory. Method All total of 116 patients admitted to Wuhan Tongji Hospital between Jan 2006 and Jan 2008 were included in this retrospective study and were classified according to treatment method. Overall, 55 cases underwent damage control operations and 61 cases underwent conventional management. The groups of patients were compared in terms of parameters such as length of operation time, time to trsuscitate from shock, lethal triad of death （LTD）, complications and treatment outcomes after operation. Results The length of operation time was （67.43 ± 19.52） min, resuscitation time from shock was （6.77 ± 3.16） h and LTD was （11.54±4.10） h in the damage control group, and （163.95±55.41） min, （22.51 ± 11.65） h and （34.55± 5.63） h, respectively, in the conventional group, with significant differences between the two groups （ P 〈 0.01 ）. The per capita complication and mortality rates were 227.27 % and 3.64 %, respectively, in the damage control group and 363.93% and 9.84%, respectively, in the conventional group （P 〈 0.05）. Conclusions Here, we demonstrated that early management of patients with multiple traumas undergoing operations by applying the damage control theory significantly decreased the operation time, and decreased time to resuscitation from shock and LTD. Furthermore, this approach significantly reduced the incidence of complications and the mortality rate of patients with severe multiple traumas.