严重多发伤的救治(附271例报告)

Management of injury in patiens with severe multiple trauma:A report of 237 cases

目的 探讨严重多发伤的损伤特点及其诊治方法。方法 回顾性分析该院 1995年 3月～ 2 0 0 2年12月救治的 2 71例严重多发伤的临床资料。非手术治疗 12例 ,手术治疗 2 5 9例。结果 伤后确诊时间平均4 .5h ,漏诊率 7.0 %。损伤脏器依次为 :四肢、腹、胸、头等。休克发生率 74 .2 % ,发生脓毒血症 2 3例 (9.7% ) ,急性肺损伤及ARDS 4 9例 (2 0 .7% ) ,MODS 2 3例 (8.5 % ) ,应激性溃疡 5 5例 (2 0 .3% )。治愈 2 2 3例 (82 .3% )。死亡 4 5例 (16 .6 % )。结论 及时控制出血 ,减轻缺血缺氧损害 ;正确掌握手术时机、及时准确地手术 ;维护重要脏器功能 ,减少内脏并发症是严重多发伤救治的关键环节。

Objective:To explore injury characteristics and management for severe multiple trauma.Methods:Results of 271 patients with severe multiple trauma treated in the hospital from 1995 to 2002 were retrospectively analyzed. 259 cases with operative treatment and 12 cases with nonoperative treatment.Results: Average time of final diagnosis after injury was 4.5 hours.The rate of missed diagnosis at early stage was 7.0 %. Number of damaged organ was limb, abdomen, chest and head in turn. Incidence of shock was 74.2%, serious sepsis in 23 cases(9.7%), acute lung ingury and ARDS in 49 cases (20.7%), MODS in 23 cases (8.5%) and stress ulcer in 55 cases ( 20.3%). Of the 223 patients(82.3%) were cured, 45 cases (17.3%) died.Conclusions: Controlling hemorrhage promptly, relieving ischemin and hypoxia,mastering accurately operation occasion and operation methods, maintaining function of the important organs, decreasing complication of internal organs are key links in treatment of the patient with serious multiple trauma.