纱布填塞压迫治疗严重肝外伤18例临床分析

Clinical analysis of gauze packing oppression in 18 cases of patients with severe liver injury of

目的：探讨纱布填塞压迫在严重外伤性肝破裂治疗中的应用效果。方法回顾性分析应用纱布填塞压迫治疗的18例严重肝挫裂伤患者的临床资料。用纱布填塞压迫，术后经止血药、抗生素和营养支持治疗，于5～7 d 开始逐渐拔除纱布，12～14 d 拔完，伤口无出血，逐渐愈合。结果治愈17例，死亡1例，治愈率95％，死亡原因为合并多发伤致多脏器功能衰竭；术后拔出纱布（或绷带）再次出血6例，2例继发出血，药物难以控制，再次剖腹手术止血；术后4例出现膈下积液、感染，并发胆瘘5例、肝脓肿2例、腹腔感染3例、切口感染3例。结论对于严重肝破裂患者纱布填塞压迫止血仍是一种紧急情况下简单有效的处理方法，适合基层医院，既是一种治疗方法，又可填塞压迫暂时止血，为送往上级医院彻底处理赢得时间，可以有效地降低患者病死率，减少并发症。

Objective To investigate the effects of application of gauze packing oppression in severe liver trauma therapy.Methods Clinical data of gauze packing oppression treated 18 patients with severe liver laceration were retrospectively analysized,with gauze packing oppression,postoperative hemostatic,antibiotic therapy and nutritional support,a t 5 -7 d began plucking gauze,12 -14 d after pulling,no bleeding wounds gradually healed. Results 17 cases were cured,1 died,the cure rate of 95%,the cause of death as multiple injuries caused by the merger of multiple organ failure;postoperative pull gauze（or bandage）again bleeding in 6 cases,2 cases of secondary hemorrhage,the drug was difficult to control again laparotomy to stop bleeding;after 4 cases of subphrenic effusion, infection,complicated with biliary fistula in 5 cases,liver abscess in 2 cases,3 cases of abdominal infection,wound infection in 3 cases.Conclusion For patients with severe liver rupture gauze packing to stop bleeding is still simple and effective ways to deal under an emergency situation for the hospital,both a method of treatment,but also packing oppression to stop bleeding temporarily for processing and then sent to a higher level hospital completely win time,can effectively reduce the mortality and reduce complications.