96例严重胸腹部血管损伤早期救治分析.docVIP

96例严重胸腹部血管损伤的早期救治分析 作者：黄显凯，张连阳，姚元章，王 韬 作者单位：(第三军医大学大坪医院野战外科研究所全军战创伤中心，重庆 400042) 【摘要】 目的 探讨严重胸腹部血管损伤的早期诊治方法。方法 2000年1月～2008年10月收治严重胸腹部血管损伤96例,其中26例到达急救部时表现明显失血性休克，经胸或腹腔穿刺抽出较多不凝血，立即送手术室紧急手术确诊;45例经64排螺旋CT 及血管造影(CTA)检查确诊;25例经数字减影血管造影检查确诊。58例行手术治疗，其中45例行血管损伤缝合修补，手术前12例行血管造影后球囊血管阻断;13例行人造血管吻合，其中3例因伤情太重而行损害控制，即严重破损血管临时插管分流，患者术后在ICU复苏待全身情况改善后于术后48小时内再行血管吻合手术。38例(盆腔腹膜后血管损伤34例，其他4例)行动脉栓塞治疗。结果 85例救治成功，救治成功率85.5%。发生严重并发症38例，其中脓毒症6例，急性呼吸窘迫综合征(ARDS)9例，多器官功能障碍综合征(MODS)23例。11例死亡，其中9例于伤后12小时内死亡，主要原因为多脏器严重损伤及失血性休克;2例于创伤后8天及16天死亡，主要原因为脓毒症及MODS。结论 胸腹部血管损伤后应快速完成检查及诊断，紧急手术行血管修复或吻合，部分腹部血管损伤及盆骨折引起的腹膜后血管损伤可用动脉栓塞治疗。 【关键词】 创伤;血管损伤;手术;血管造影;动脉栓塞 Analysis of early remedy for 96 cases of severe thoracicand abdominal vascular injuries 　　HUANG Xiankai,ZHANG Lianyang,YAO Yuanzhang,et al. 　　(Trauma Center,Institute of Surgery Research,Daping Hospital，Third Military Medical University, 　　Chongqing 400042,China) 　　Abstract： Objective To explore methods of early diagnosis and treatment for severe thoracic and abdominal vascular injuries.Methods Ninetysix patients with severe thoracic and abdominal vascular injuries were diagnosed and treated from Jan.2000 to Oct.2008.Twentysix cases of hemorrhagic shock admitted to emergency department were operated immediately and diagnosed,because no clotting blood was drawn out through thoracocentesis or peritoneocentesis;45 cases were diagnosed by spiral CT and angiography(CTA);25 cases were diagnosed by digital substraction angiography.Fiftyeight patients were taken operation: blood vessel suture and repair in 45 cases;angiography and blocking blood vessels by sacculus proprius in 12 cases before operation;artificial blood vessel anastomosis in 13 cases,of whom,3 cases received damage control because of severe injury,the process of which was to shunt by intubation for blood vessel injury,then take resuscitation for improving general condition,and vascular anastomosis within 48 hours;arterial embolization in 38 cases.Results E