损伤控制性手术在严重创伤性肝破裂患者急救中的应用效果

Application effect of damage control surgery in first aid of patients with severe traumatic liver rupture

目的探讨损伤控制性手术在严重创伤性肝破裂患者急救中的应用效果。方法回顾性分析2018年9月至2020年5月我院急诊科收治的86例严重创伤性肝破裂患者的临床资料,按治疗方式的不同将患者分为A组(43例,一期确定性手术治疗)和B组(43例,损伤控制性手术治疗)。比较两组的治疗效果。结果B组的抢救成功率显著高于A组,并发症总发生率显著低于A组(P<0.05)。B组的手术时间、体温恢复时间、乳酸清除时间及住院时间均显著短于A组,术中出血量显著少于A组(P<0.05)。术后6 h,两组的APTT、TT、PT均缩短,且B组显著短于A组(P<0.05)。术后5 d,两组的ISS评分均降低,且B组显著低于A组(P<0.05)。结论损伤控制性手术在严重创伤性肝破裂患者急救中的应用效果显著,可有效控制肝脏损伤严重程度,促进凝血功能恢复,进而提高抢救成功率,降低并发症发生率,改善围术期相关指标。

Objective To explore the application effect of damage control surgery in first aid of patients with severe traumatic liver rupture.Methods The clinical data of 86 patients with severe traumatic liver rupture treated in the emergency department of our hospital from September 2018 to May 2020 were retrospectively analyzed.According to different treatment methods,the patients were divided into group A(43 cases,one-stage deterministic surgical treatment)and group B(43 cases,damage control surgery treatment).The therapeutic effects of the two groups were compared.Results The rescue success rate in the group B was significantly higher than that in the group A,and the total incidence of complications was significantly lower than that in the group A(P<0.05).The operation time,temperature recovery time,lactate clearance time and hospital stay in the group B were significantly shorter than those in the group A,and the amount of intraoperative bleeding was significantly less than that in the group A(P<0.05).At 6 h after operation,APTT,TT and PT in the two groups shortened,and those in the group B were significantly shorter than the group A(P<0.05).At 5 d after operation,the ISS score in the two groups decreased,and that in the group B was significantly lower than the group A(P<0.05).Conclusion Damage control surgery in first aid of patients with severe traumatic liver rupture has a significant application effect,it can effectively control the severity of liver damage and promote the recovery of coagulation function,thereby increasing the success rate of rescue,reducing the incidence of complications,and improving perioperative related indicators.