严重多发伤的急诊救治分析

Clinical analysis of emergency diagnosis and treatment in severe multiple injury patients

目的 总结严重多发伤的急救经验,探讨多发伤的致伤因素和早期诊治策略对预后的临床意义.方法 选取本院急救部自2008年1月～ 2013年1月收治的严重多发伤患者,均给予损伤严重度评分（ISS）,以ISS≥16分为研究对象,最终入选患者385例.回顾性分析这些患者的致伤原因、致伤部位、治疗方法及预后.结果 分析发现多发伤主要致伤原因为道路交通伤（223例,57.92％）和坠落伤（77例,20.0％）;多同时合并其它部位损伤,如：颅脑损伤（207例,53.77％）,胸部损伤（162例,42.08％）,骨盆四肢损伤（123例,31.95％）,腹部损伤（101例,26.23％）.随着ISS评分的增高,患者死亡率亦随之增加（P＜0.01）,特别是合并颅脑损伤患者死亡率明显升高（P＜0.01）.结论 多发伤致病因素多样,交通伤为主要致伤因素.ISS评分对评估创伤患者严重程度及预后有一定的意义,以限制性液体复苏和损害控制外科为主导的综合治疗可减少并发症,提高多发伤救治成功率.

Objective To comprehensively study the experience of severe multiple injury emergency,and to explore factors and the predictive significance of early diagnosis and treatment of multiple injury.Methods Totally 385 severe trauma patients （ISS ≥ 16） in our emergency department from Jan.2008 to Jan.2013 were retrospectively analyzed for their trauma causes and sites as well as therapeutic methods and prognosis.Results Traffic accident （223 cases,57.92％）and falling（77 cases,20％）were the main trauma causes of multiple injury.The main involved sites included head （207 cases,53.77％）,chest （162 cases,42.08％）,pelvis and limbs （123 cases,31.95％）,abdomen（101 cases,26.23％）.With the increase of ISS score,the death rate increased（P ＜0.01）,especially when they were associated with head injury（P ＜0.01）.Conclusion Traffic accident is the major cause in the diverse causes of multiple injury.ISS score makes some sense in evaluating severity level and assessing its prognosis.Moreover,the comprehensive treatment led by limited fluid resuscitation and damage control surgery can decrease complications and improve the survival rate of multiple injury.