355例以腹部损伤为主的严重创伤救治分析

Management of 355 patients with abdominal injuries in severe trauma

目的探讨腹部损伤为主的严重创伤的诊断及救治措施。方涪对1999年9月-2012年9月救治的355例以腹部损伤为主的严重创伤进行分析总结。结果 本组急诊腹部手术319例少次、其中103例少次柱一次麻醉下分组同台完成了两个以上部位的手术。重症监护病房（ICU）平均住院日28．6±10.8天。临床治愈237例（668％），致残78例（22．0％），死亡40例（11、2％）。结论 病史和体格检查应同抢救治疗同步（如维持呼吸道通畅、止血措淹，执休克等）应积极采用渗断性腹腔穿刺、B超、CT等比较简洁和敏感的快速诊断方法 手术顺序应控受损器官的重要性和损伤的严重程度决定，尽可能在一次麻醉下分组同台处理不同部位的损伤 主动采用损伤控制性外科（Dcs）策略，可有效降低死亡率。严重多发伤病人术后均应进入ICU监护和治疗。

Objective To discuss the diagnosis and treatment of abdominal injury in severe trauma. Methods The data of 355 cases of abdominal injuries with severe trauma in our hospital from Sept. 1999 to Sept. 2012 were analyzed. Results 319 patients underwent immediate abdominal operations.103 patients received over two operations on different anatomic regions under a single anesthesia. Mean length of stay in the intensive care unit was 28.6±10.8 days. 237 cases had a good recovery, 78 cases were disability and 40 cases died. Conclusion Diagnostic peritoneocentesis and Ultrasound are rapid and accurate modalities for the diagnosis of intraabdominal injury. CT is sensitive for the evaluation of abdominal injury in hemodynamically stable patients. The operation sequence should be depended on the importance and the injury severity of the involved organ. The operations on different anatomic regions should be done as far as possible under a single anesthesia. Damage control surgery would effectively reduced mortality rate.