损伤控制性手术在高原偏远地区严重腹部外伤救治中的应用

Application of damage control surgery in the treatment of severe abdominal trauma in Plateau remote area

目的探讨损伤控制性手术(damage control surgery,DCS)在高原偏远地区严重腹部外伤救治中的应用价值。方法选取我院2012年1月~2016年12月收治48例严重腹部外伤患者作为观察对象,根据治疗方法的不同分为DCS组和对照组,各24例。DCS组实施DCS,对照组实施常规手术治疗。比较两组患者的术后凝血功能(PT、APTT)恢复时间、体温恢复时间、乳酸清除时间、住院时间以及术后并发症发生情况。结果两组患者致伤原因以车祸伤为主,且在重物砸击伤、高空坠落伤、刀刺伤以及挤压伤上差异无统计学意义(P>0.05);两组患者损伤严重程度评分(ISS)平均为(41.26±4.46)分,差异无统计学意义(P>0.05),DCS组患者的PT及APTT恢复时间、乳酸清除时间以及体温恢复时间显著低于对照组,差异有统计学意义(P<0.05);两组患者在单项并发症方面比较,差异无统计学意义(P>0.05),DCS组患者在术后肺部、腹腔以及粘连性肠梗阻感染明显较对照组低,差异有统计学意义(P<0.05)。结论 DCS在高原偏远地区严重腹部外伤救治与常规手术相比具有较高的临床应用价值,可以明显缩短患者凝血功能恢复时间、乳酸清除时间以及体温恢复时间,且术后并发症发生率低,值得推广应用。

Objective To investigate the value of damage control surgery in the treatment of severe abdominal trauma in Plateau remote area.Methods 48 severe abdominal trauma patients from January 2012 to December 2016 in our hospi- tal were selected as observation objects and retrospectively analyzed.Patients were divided into DCS group and control group according to different treatment method,and each group was 24 cases.DCS group was used damage control surgery,and the control group was used general surgery.The recovery time of postoperative blood coagulation function （FF,APTT）,temperature recovery time,lactate clearance time,hospitalization time and postoperative complications were compared and analyzed between the two groups.Results The two groups were mainly caused by traffic injuries,and there was no significant difference in weight injuries, high-altitude falling injuries, stab injuries and erush injuries （P〉0.05）. The averaged injury severity score （ISS） of the two groups was （41.26±4.46） scores,and the difference was not statistically significant （P〉0.05）.PT and APTT recovery time,lactic acid clearance time and body temperature recovery time were significantly lower in the DCS group than those in the control group （P〈0.05）.In terms of individual complications,the difference was not statistically significant between two groups （P〉0.05）.The postoperative lung, abdominal cavity and ad- hesive intestinal obstruction infection in group DCS were significantly lower than those in the control group,the differ- ence was statistically significant （P〈0.05）.Conclusion Damage control surgery in the treatment of severe abdominal trauma in the remote areas with a high clinical value compared with conventional surgery,which can significantly short- en the blood coagulation function recovery time,clearance time of lactic acid and body temperature recovery time,and with low incidence of postoperative complications,and is worthy of promotion and application.