骨盆骨折合并大出血的处理

VIP in treatment of major hemorrhage related to pelvic fractures

骨盆骨折往往由严重的外伤造成,常系多发伤的一个组成部分。由于失血量大,往往合并休克,严重骨盆骨折的死亡率为25%～39%。处理骨盆骨折合并大出血的核心内容是抗休克及控制失血。我院自1985年以来,实施VIP抢救程序对包括骨盆骨折在内的近万例危重多发伤进行院内急救取得满意疗效。按抢救的时间顺序以Ventilation(V),Infusion(I),Pulsation(P)三大步骤抢救病人。以V程序建立正常通气后,以I程序扩容抗休克,在判断失血量的前提下以快、足、稀方案扩容抗休克,稳定周围循环。抗休克裤,放射介入性治疗,以及生理性自行止血可使大部分病人的出血得到控制。只有少部分病人需手术止血。心泵障碍的病人要以P程序予以排除,保证正常泵血。

Most pelvic fractures were commonly seen in polytrauma caused by violent forces,and often complicated with hemorrhagic shock,with mortality being 25%～39%.Anti-shock and control of bleeding are th e philosophy of treatment of this critical condition.Since 1985,hundred s of pelvic fracture victims have bee n sal-vaged in my hospital by VIP procedure which means ventilation(V),infusion(I),and pulsation(P).First,V was to establish an airway,then I was to manage hypovolumic shock,and fin ally,P was to improve the impaired heart function to maintain normal hemodynamics and tissue perfusion.It was necessary for antishock therapy to infuse rapidly and sufficiently in o rder to gain diluted blood.Pneumatic antishock garment,angiography an d em-bolism,and retroperitoneal tampon aded bleeding could control most hem orrhage associated with pelvic fractures.[