腹部损伤为主的严重多发伤急救外科策略及效果探讨

Surgical strategy and effect of emergency treatment for severe multiple injuries with abdominal injuries

目的探讨应用损害控制策略在以腹部损伤为主的严重多发伤外科救治中的疗效,分析救治方案,总结救治经验,降低病死率,提高救治成功率。方法选取2015年2月至2016年3月期间入院进行以腹部损伤为主的严重多发伤救治患者100例进行回顾性分析,采用损伤严重度评分(ISS)对患者进行分类评估,术前ISS评分>35分的分为常规治疗组(ETC组)54例和损害控制策略组(DCS组)46例,复苏期间检测两组患者的手术时间、术中出血量、乳酸清除时间、体温恢复时间、凝血酶原时间(PT)。数据采用SPSS 20.0统计学软件进行分析。患者一般资料、手术后临床数据用(x珋±s)表示,采用t检验;两组患者术后并发症发生率、病死率采用χ2检验,P<0.05代表组间差异有统计学意义。结果复苏期间两组患者的手术时间、术中出血量组间差异无统计学意义(P>0.05);DCS组的乳酸清除时间、体温恢复时间、PT、病死率(13.0%)均显著小于ETC组(29.6%),组间差异均具有统计学意义(P<0.05)。结论利用损害控制策略对腹部损伤为主的严重多发伤进行救治能够有效地降低病死率,在提高抢救成功率方面具有良好的成效。

Objective To investigate the efficacy of the injury control strategy in surgical treatment of severe multiple injuries with abdominal injuries , and analyzed the treatment plan, sum up the experience of treatment, reduce the fatality rate, and improve the success rate of treatment . Methods 100 cases patients with severe multiple injuries with abdominal injuries were objects for study , which had treated in our hospital during 2015.02 to 2016.03, all patients divided into classification by injury severity score （ISS）, preoperative ISS score 〉35 points divided into routine treatment group （ETC group, n =54） , 46cases of damage control group （DCS group）, during the recovery period, compared the operation time, bleeding amount, lactic acid clearance time, temperature recovery time, and prothrombin time, et al.All data were analyzed by SPSS 20 statistical software.The general data expressed by （ -x ±s）, analyzed by t test.The complications, mortality analyzed by χ2 test, P 〈0.05 expressed the difference between the groups was statistically significant. Results The operation time and intraoperative blood loss had no statistical difference between groups （P 〈0.05）.The lactic acid clearance time, body temperature recovery time, PT, fatality rate （13%） of DCS group was lower than ETC group , and the difference was statistically （ P 〈0.05）. Conclusions Damage control strategy to treat severe multiple injuries with abdominal injuries can effectively reduce the fatality rate and improve the success rate of rescue .