多发伤患者肢体急诊选择性显微外科手术及康复治疗

Selective Emergency Microsurgery and Rehabilitative Treatment Interventions for Treatment of the Involved Extremities in Patients with Multiple Injury

目的 :探讨急诊实施抢救生命手术的同时行肢体显微外科手术修复 ,并注意发挥“全程功能康复链”在治疗过程中的作用。方法 :选择 4 4例需行显微外科手术修复的多发伤患者 ,在实施抢救生命手术的同时或之后实施急诊显微修复手术 ;并注意患者术前、术中及术后 3个不同阶段的康复治疗。结果 :4 4例患者均成功度过手术 ,其中 2例分别在术后 4和 6d时出现肺炎 ,经更换抗菌素等治疗 ,3周后治愈 ;5 6例次的显微外科手术中 3例次出现血管危象 ,经补充血容量、手术探查及止痛等治疗后危象消失 ,显微外科手术均获成功。结论 :对多发伤患者实施抢救性手术的同时或之后 ,行有条件的肢体急诊显微外科手术修复及相关的“功能康复链”治疗 ,可提高患者的救治效果 ,降低术后各种并发症的发生 ,是一种可谨慎开展的积极治疗方法。

Objective: To discuss how to practise microsurgery toical repair of the involved extremities in patients with the multiple y-injured injury patient's extremities after or at the same time ofsimultaneously with the emergency life-saving operation and how to bring ”the whole functional rehabilitation chain” into full play during the therapy process. Methods: In In 44 patients with multiple injury accompanied with injured involving their extremities which needed microsurgery toical repair, 56 cases/times of emergency microsurgeries microsurgical procedure were performed to repair the multiply-injured patient'sinvolved extremities after or simultaneously with at the same time of the emergency life-saving operation. Rehabilitative treatments were was carried out at three different stages: before, during and after the microsurgery.ical repair. Results: All these 44 patients succeeded in passingtolerated the operations well. AmongOf them, 2 were suffered from pneumonias in on the 4th d and 6th days respectively after the operation. By use of After effective therapies such as changing antibiotics, they were cured after in 3 weeks. In the 57 cases/times of microsurgeriesmicrosurgical operations, blood vessel crisis occurred in 3 cases. Crisis was diminished, which was alleviated by compensating such interventions as blood volume compensation, surgically explorationing, relieving pain reliefand so on. All the microsurgeries succeeded. Conclusion: For multiply-injured patients, the practice of conditional extremities emergency microsurgical intervention, after or simultaneously withat the same time of life-saving operations, of conditional extremities emergency microsurgeries and correlative ”functional rehabilitation chain” treatments can improve the effectiveness outcome and decrease the occurrence of various post-surgical complications.