损伤控制急救严重腹部创伤192例

Emergency damage control treatment for the severe abdomen trauma of 192 cases

目的:探讨损伤控制(DC)急救在严重腹部创伤中的应用效果。方法:回顾性分析将损伤控制急救应用于192例严重腹部创伤患者的救治情况和治疗效果。结果:192例患者均完成院前急救,186例完成损伤控制性手术(DCO)救治,184例进入外科重症监护病房(SICU)复苏,177例接受不同方式的再次确定性手术治疗。急救过程中,各项异常指标在DCO后72h内逐渐恢复正常。治愈出院174例(90.6%),其中再次手术术后出现并发症4例(2.3%),经保守治疗痊愈;死亡12例(6.2%),死亡原因与损伤控制急救技术无关。结论:符合指征的严重腹部创伤的患者,应积极选择适宜的损伤控制急救方式,并应根据损伤的不同部位和程度,分步骤治疗。

Objective： To explore the application experiences and effects of emergency damage contro（lDC）treatment for severe abdomen trauma. Methods： The clinical data of 192 patients with severe abdomen trauma were selected as the object of this study. A retrospective analysis was done on therapy condition and effects of emergency damage control treatments. Results： Pre-hospital emergency care was performed in all 192 patients, damage control operations （DCO）were done in 186 cases, 184 cases entered surgical intensive care unit （SICU）for resuscitation, and 177 cases were adopted corresponding reoperations after SICU resuscitation. The abnomal DCO indices recovered gradually in the 72 hours after DCO. The cure rate was 90.7% with 174 cases, and the incidence of complication was as low as 2.3% with 4 cases after reoperations, and the 4 cases all healed by conservative treatments. Mortality rate was 6.2% with 12 cases, and it caused by associated organs injuries, severe primary disease and secondary infection of other organs. Conclusion： Emergency damage control treatment modus should be chosen positively and eligibly under indication to severe abdomen trauma patients. According to the difference of location and degree of injury, eligible therapies by stages are the key managements.