损伤控制性手术在车祸肝脏损伤患者治疗中的应用

Application of damage control surgery in the treatment of liver trauma caused by traffic accident

目的探讨损伤控制性手术在车祸肝脏损伤患者治疗中的应用价值。方法回顾性分析2005年1月至2015年12月因车祸在中山大学孙逸仙纪念医院及广州市增城区人民医院接受治疗的103例急性严重肝脏损伤患者临床资料。按照治疗方案分为损伤控制组和对照组。损伤控制组52例,其中男40例,女12例;平均年龄(30±5)岁;实施损伤控制性手术,先对腹部创伤进行快速处理,待患者生理状况相对稳定后再行确定性手术。对照组51例,其中男41例,女10例;平均年龄(31±5)岁;实施肝裂伤创面致密缝合。患者均签署知情同意书,符合医学伦理学规定。观察两组患者手术时间、术中出血量等围手术期情况。两组正态分布资料的比较采用t检验,率的比较采用χ~2检验。结果损伤控制组的手术时间为(109±12)min,明显短于对照组的(191±13)min(t=-32.97,P<0.05);损伤控制组的术中出血量为(2 021±301)ml,明显低于对照组的(3 074±460)ml(t=-13.77,P<0.05);损伤控制组的ICU住院时间为(11±4)d,明显长于对照组的(7±3)d(t=4.81,P<0.05);损伤控制组的死亡率为12%(6/52),明显低于对照组的27%(14/51)(χ~2=4.166,P<0.05)。结论采取损伤控制性手术方案治疗车祸所致严重肝脏损伤是有效、安全的,其可以缩短治疗手术时间、降低术中出血量和死亡率。

Objective To investigate the application value of damage control surgery in the treatment of liver trauma caused by traffic accident. Methods Clinical data of 103 patients with acute severe liver trauma caused by traffic accident who were treated in Sun Yat-sen Memorial Hospital affiliated to Sun Yat-sen University and Zengcheng District People＇s Hospital of Guangzhou between January 2005 and December 2015 were retrospectively analyzed. All patients were divided into the damage control group （n=52） and the control group （n=51） according to treatment protocols. In the damage control group, 40 were males and 12 were females with the avarage age of （30±5） years old. The damage control surgery was performed. Firstly abdominal wound was rapidly processed, and then definitive surgery was performed after the physiological status of the patients was relatively stable. In the control group, 41 were males and 10 were females with the avarage age of （31±5） years old. The liver laceration wound surface was tightly sutured. The informed consents of all patients were obtained and the local ethical committee approval wasreceived. The perioperative conditions such as the operation time and intraoperative blood loss of two groups were observed. The normal distribution data of two groups were compared using t test, and the ratio was compared using Chi-square test. Results The operation time in the damage control group was （109±12） min, significantly shorter than （191±13） rain in the control group （t=-32.97, P〈0.05）. The intraoperative blood loss in the damage control group was （2 021±301） ml, significantly less than （3 074±460） ml in the control group （t=-13.77, P〈0.05）. The length of ICU stay in the damage control group was （11±4） d, significantly longer than （7±3） d in the control group （t=4.81, P〈0.05）. The mortality in the damage control group was 12%（6/52）, significantly lower than 27%（14/51） in the control group （χ2=4.166, P〈0.05）. Conclusions Damage control surgery is an efficacious and safe treatment for severe liver trauma caused by traffic accident. It can shorten the operation time, reduce the intraoperative blood loss and mortality.