多发伤的急诊一期手术处理及肺部并发症的防治探讨

Discuss on Primary Operative Treatment and Prevention of Pulmonary Complications of Multiple Trauma

目的 探讨多发伤行急诊一期手术处理的优越性及肺部并发症防治的主要措施。方法 通过创伤严重度综合评定计分法对 379例多发伤患者进行伤情回顾 ,分析急诊一期手术处理情况 ,分析呼吸机相关性肺炎 (VAP)的菌谱及药敏结果。结果 379例多发伤患者中 ,轻中度 36例 (12 93% ) ,重度 16 8例 (44 33% ) ,危重度 117例 (30 87% ) ,极危重度 45例(18 75 % )。机械通气治疗者平均使用时间为 7 19± 2 43d ,发生呼吸机相关性肺炎者菌谱分析示G- 菌占 5 4 72 % ,G+ 菌占 38 0 7% ,真菌占 7 2 1% ,其中混合感染占 2 8 86 %。全组死亡率17 15 % ,急诊一期手术治疗组死亡率 9 38%。结论 通过创伤严重度综合评定计分方法的应用 ,可以快速准确且简易地评估入院时患者的伤情 ;通过急诊一期手术的处理 ,可以有效地提高病人抢救的成功率 ;ARDS病人尽量缩短机械通气时间 ,VAP患者正确合理地应用抗菌药物 ,可以有效防治肺部并发症 ,以期降低死亡率。

Objective To discuss the advantages of primary surgical treatment and major measurements in preventing pulmonary complications of multiple trauma.Methods The combined scoring for trauma,primary surgical treatment,pathogenic bacteria and drug sensitivity in ventilator associated pneumonia(VAP) were analyzed in 379 cases of multiple trauma.Results In 379 cases,36 cases with mild trauma,168 cases with severe trauma,117 cases with critical risky trauma,and 45 cases with highly critical risky trauma,the percentage was 12 93%,44 33%,30 87%,and 11 87% respecfively.273 cases(72 03%) were treated with operation.There were 128(46 89%) primary operation.The averase mechanical ventilation time was 7 19±2 43 days,and infective bacterium of VAP was G - bacillus 54 72%,G + bacillus 38 07%,fungus 7 21%,and mixed infection 28 86%, with total mortality 17 15%,the mortality in the group of primary operation was 9 38%.Conclusion It is to assess multiple trauma with combined scoring for trauma.Meanwhile,shorten the mechanical ventilation time in ARDS cases,proper application of antibiotics are major measurements in prevention of VAP.