损伤控制理念在重症高处坠落伤急诊救治中的应用

Effect of damage control surgery conviction in emergency treatment of severe high falling injury

目的:探讨高处坠落伤的临床特点及损伤控制理念在急诊救治中的应用。方法:对2007年2月-2009年6月应用损伤控制外科(DCS)急诊救治的32例重症高处坠落伤临床资料进行回顾分析。32例重症高处坠落伤立即给予液体复苏,急诊手术止血和控制污染,然后置EICU行重症监护治疗,待生命体征基本稳定后分期进行确定性手术和后续治疗。结果:复苏期患者血pH、体温、PT值与一般高处坠落伤患者相比,在第1天差异有统计意义(P<0.05),在第2天差异无统计学意义(P>0.05),而血乳酸均显著高于一般高处坠落伤患者(P<0.05);本组23例治愈出院,死亡9例(脑疝3例,MOF6例),抢救成功率为72%。结论:重症高处坠落伤伤情复杂,病死率高,主动实施损伤控制策略开展救治是当前急诊救治较好的模式。

Objective：To study the effect of damage control surgery in the emergency treatment of severe high falling injury.Method：A retrospective analysis was made on the clinical data of 32 cases with severe high falling injury treated by damage control surgery conviction from 2007 February to 2009 June.32 cases with severe high falling injury were treated by immediate fluid resuscitation and emergency operation,so that to control the bleeding and contamination.The definitive operation was operated as soon as the vital signs became stable in EICU.Result：The body temperature,serum pH and prothrombin time （PT） level of patients during resuscitation in EICU were significantly different from those of common high falling injury patients on the first day （P〈0.05）,but there were no significant difference on the second day（P〉0.05）; the serum lactic acid levels were all significantly higher than those of common high falling injury patients （P〈0.05）.There were 23 cases healing,9 cases dead of cerebral hernia and multiple organ failure.Conclusion：The severe high falling injury is complicated and has high death rate,and effect of damage control surgery conviction in emergency treatment of it is a better measure.