损伤控制策略在创伤性心脏破裂救治中的应用

Damage control surgery for treating traumatic cardiac rupture

目的：探讨损伤控制外科（ DCS）理念在创伤性心脏破裂中的应用策略和临床价值。方法对27例创伤性心脏破裂患者采用DCS处理的临床救治进行回顾性分析。所有患者主张适时分阶段的救治措施，在早期行心包穿刺置管减压的救命处理后，行进一步开胸心脏修补止血的确定性手术，并有计划的分期行其他合并伤的处理。结果所有患者经急诊室DCS处理后，心率立即较前减慢，1例经严密观察保守治疗后出院；2例行急诊室开胸心包切开减压，予以胸内心脏按压后转手术室探查；其余24例经急诊室处理后，均顺利转手术室开胸探查。2例死亡，其余均痊愈出院。结论创伤性心脏破裂的救治中贯彻DCS理念，既最大限度降低了创伤对患者的损害，又尽可能保存了机体的生理功能，合理应用DCS既可避免盲目手术，又可避免延误手术，有效提高患者救治成功率。

Objective To explore the clinical application of damage control surgery （DCS） in the treatment of traumatic cardiac rupture .Methods The clinical data of 27 traumatic cardiac rupture patients who treated with DCS concept were collected to analyze retrospectively .All patients were treated timely according to disease stages .After withdrawn intermittently by percutaneous pericardial drainage with the central venous catheter in the emergency room and anti -shock treatment , the patients were immediately switched to operating room for exploratory thoracotomy .Results DCS in the emergency room effectively slowed down the heart rate in all patients .1 patient was cured by conservative treatment without receiving operation under strictly monitoring . 2 patients were immediately cut pericardial decompression in the emergency room and carried out cardiac massage in the thoracic .Out of the 27 patients, 2 patients died and all the others were cured .Conclusion DCS can not only protect the physiological functions from the damage of trauma , but also can avoid an unnecessary surgery or a delayed surgery , therefore the saving rate for traumatic cardiac rupture patients is raised .