损伤控制外科在严重多发伤救治中的临床应用

Damage Control Surgery in the Treatment of Severe Multiple Injuries

目的探讨和总结损伤控制外科(damage control surgery,DCS)技术在抢救严重多发伤中的治疗和处理。方法回顾性分析129例严重多发伤(ISS评分平均34.2分)患者采取DCS技术治疗的临床效果。结果 129例严重多发伤患者中,采用DCS技术后存活102例,死亡27例,死亡率20.93%(27/129)。死亡27例中,早期死于急性大出血11例,严重颅脑损伤5例,严重胸部损伤3例,颈椎骨折并高位截瘫2例,晚期2例死于ARDS,4例死于MOF。结论将DSC技术合理使用在严重多发伤的抢救中,能增加患者的"生理潜能",纠正严重的内环境紊乱,使安全度过创伤的急性反应期,能够明显提高患者的生存率,有相当的临床使用价值。

Objective To discuss and summarize the damage control surgery（DCS） in the treatment of severe multiple injuries. Methods Retrospective analysis of 129 patients with severe multiple trauma （ with a mean ISS score of 34.2 points） treated by DCS was conducted. Results There were 102 patients survived and 27 patients died; with the mortality rate of 20.93% （27/129）. There were 5 patients died of severe head injury, 3 patients of severe chest injury, 11 patients of acute bleeding, 2 patients of cervical spine fractures and paraplegia, 2 patients of ARDS and 4 patients of MOF. Conclusions The rational use of the DCS in the rescue of severe multiple injuries can increase the patient＇s ＂physiological potential＂ to correct a serious disturbance in the internal environment, so that can lead the patients to placidly live through the trauma of the acute reaction, and can significantly improve the survival rate.