损伤控制策略在严重创伤救治中的应用价值

Application of Damage Control Surgery Principles in Severe Traumas Resuscitation

目的探讨损伤控制(damage control,DC)策略在严重创伤救治中应用的临床效果。方法对医院应用损伤控制策略救治的35例严重创伤患者的临床资料进行回顾性分析。按损伤控制外科(damage control surgery,DCS)纳入标准入组的35例严重创伤患者进行急诊手术控制出血和污染,同时给予液体复苏,在休克逐渐得到纠正,生命体征基本稳定后,再进行确定性手术治疗。结果本组29例患者痊愈出院,救治成功率82.9%。2例死于发展很快的失血性休克,1例死于脑疝,1例死于难以控制的感染,2例死于多器官衰竭(MODF)。结论针对严重创伤的特点,对严重创伤患者按损伤控制策略选取合适对象进行救治,在复苏的同时尽快采取简单省时的手术控制出血和污染,病情稳定后再进行后续治疗,可提高严重创伤患者的治愈率和生存率,减低患者的死亡率。

Objective To evaluate the effect of damage control surgery principles in the treatment of severe traumas.Methods A retrospective analysis was made on the clinical data of 35 cases treated by damage control surgery principles in severe traumas from 2007 to 2011.A total of 35 cases selected with the rules of DCS were treated by immediate fluid resuscitation and emergency operation,so that to control the bleeding and contamination,traumatic shock was controlled after DCS,the definitive operation was operated as soon as the vital signs became stable.The definitive operation was performed successfully.Results Except for 6 patients including 2 cases dead of developing hemorrhagic shock,1 case dead of severe brain contusion and cerebral hernia,1 case dead of hard controlling infection and 2 cases dead of multiple organ dysfunction failure（MODF）,29 patients were cured with a cure rate of 82.9%.Conclusion The management of damage control surgery principles could obviously increase the survival rate for treatment of severe traumas,the successful operative control of bleeding and contamination while resuscitation and definitive operation performed will contribute a lot to a high curative rate,the correction and application of DCS can decrease the mortality of the wounded in the serious traumas.