损伤控制与加速康复外科理念在心脏刀刺伤急救中应用

Clinical application of damage control and fast track surgery in the first aid of cardiac stabbed

目的探讨损伤控制与加速康复外科理念在心脏刀刺伤急救中的临床应用价值。方法对19例心脏刀刺伤采用损伤控制与加速康复外科理念手术急救进行回顾性分析总结。所有患者在急诊室迅速建立静脉通道,输液、输血扩容抗休克治疗,其中2例由于心脏压塞出现心搏骤停,立即在急诊室行心包切开减压,胸内心脏按压。急诊室处理后立即转手术室进行剖胸探查术。结果 19例无一例死亡。5例由于合并瓣膜和(或)房室间隔损伤,术后2月在体外循环下行二次手术。所有患者术后随访3～12个月,生活质量、劳动能力均基本恢复正常。结论对心脏刀刺伤患者的急救,按照损伤控制与加速康复外科理念,采取合理的手术方式及术后处理,可以促进患者早日康复。

Objective To explore the clinical application of damage control surgery（DCS） and fast track surgery（FTS） in the first aid of cardiac stabbed.Methods 19 cardiac stabbed patients in our hospital treated with DCS and FTS concept in emergency surgery were retrospectively analyzed and summarized.All patients in the emergency room quickly to establish intravenous access,infusion,transfusion and anti-shock treatment.2 patients were immediately cut pericardial decompression in the emergency room and carried out cardiac massage in the thoracic due to cardiac tamponade and cardiac arrest occurred.After emergency room treatment,the patients were immediately switched to operating room exploratory thoracotomy.Results None of the 19 patients died.5 patients combined of valve and/or atrioventricular septal defect were treated with second surgery in cardiopulmonary bypass about 2 months later.All patients were followed up for 3 to 12 months,both quality of life and ability to work returned to normal.Conclusion For the first aid of cardiac stabbed patients,preference of DCS and FTS concept,to take reasonable surgical procedure and postoperative management,can promote patient recovery.