应用损伤控制外科策略救治严重烧创复合伤

APPLICATION OF DAMAGE CONTROL SURGERY STRATEGY IN TREATMENT OF BURN-TRAUMA COMBINED INJURY

目的探讨损伤控制外科(damage control surgery,DCS)策略在严重烧创复合伤救治中的应用效果。方法 2004年1月-2009年12月,对28例严重烧创复合伤患者按照DCS策略进行抢救治疗。男18例,女10例;年龄8～56岁,中位年龄39.5岁。烧伤面积为(15%～56%)总体表面积,损伤严重度(ISS)评分为25～56分,创伤指数为17～24分。均出现DCS致死三联征。烧伤合并2个解剖部位损伤12例,3个6例,4个及以上10例。现场急救后收治住院16例,外院转入12例;受伤至入院时间20min～36h。给予液体复苏、急诊手术控制出血、清除严重污染、生物敷料暂时覆盖创面,生命体征稳定后行系统手术治疗。结果术后死亡2例,其中1例死于多器官衰竭,1例死于严重脑外伤合并重度休克;余26例患者中23例创面Ⅰ期愈合出院,3例残余少许创面出院;住院时间31～398d,平均62d。结论应用DCS策略可提高严重烧创复合伤患者抢救成功率。

Objective To explore the application of damage control surgery（DCS） strategy in the treatment of severe burn-trauma combined injury.Methods From January 2004 to December 2009,28 patients with severe burn-trauma combined injury received salvage treatment according to DCS,including 12 cases of burn combining injury at 2 sites,6 cases of burn combining injury at 3 sites,and 10 cases of burn combining injury at 4 sites or above.There were 18 males and 10 females with a median age of 39.5 years（range,8-56 years）.The burn area was 15% to 56% of total body surface area.The injury severity score a（ISS） was 25 to 56,and the traumatic index was 17 to 24.Lethal triad syndrome occurred in all patients.Of them,16 cases were on admission immediatly after first-aid,and 12 cases were thansferred from other hospitals.The time from injury to hospitalization was 20 minutes to 36 hours.All patients were treated by immediate fluid resuscitation and emergent operation to control hemorrhage and contaminations.Biological dressings were used to seal the wounds provisionally.The systemic therapy was carried out as soon as the vital signs of the patients became stable.Results In 26 survivors,23 achieved wound healing by first intention,3 had a little residual wound at discharge.The hospitalization days were 31 to 398 days（62 days on average）.However,1 patient died of multiple organ failure,another 1 patient died of severe cerebral trauma with refractory shock.Conclusion The DCS strategy is effective in reducing mortality of patients with severe burn-trauma combined injury.