损伤控制护理在救治重型骨盆骨折患者中的效果观察及体会.docVIP

损伤控制护理在救治重型骨盆骨折患者中的效果观察及体会 　　[摘要] 目的 探讨损伤控制（Damage control orthopedics，DCO）原则在重型骨盆骨折患者护理中的应用效果。方法将2001年3月～2013年12月收治的117例重型骨盆骨折患者按是否遵循DCO的救治原则分为对照组（n=48）及观察组（n=69）。观察组采用DCO策略，实施挽救生命+骨盆外固定支架固定，待全身情况好转再行确定性处理的损伤控制性护理，对照组行早期手术治疗，采用传统的护理方法。观察两组患者的乳酸清除时间、体温恢复时间、APTT恢复时间及PT恢复时间的差异性，比较两组患者ARDS、MOF发生率及致残、死亡例数。结果 观察组患者的乳酸清除时间、体温恢复时间、APTT恢复时间及PT恢复时间均显著减少（P 0.05），观察组ARDS、MOF发生率及致残、死亡例数较对照组低，差异有统计学意义（P 0.05）。 结论 采用DCO原则救治护理重型骨盆骨折患者，能减少严重并发症、降低骨盆骨折致残率和死亡率、提高患者的生存质量和救治护理效果。 　　[关键词] 损伤控制；重型；骨盆骨折；护理 　　[中图分类号] R473.6 [文献标识码] B [文章编号] 1673-9701（2014）22-0089-03 　　[Abstract] Objective To study the nursing effect of damage control orthopedics （DCO） applied in patients with severe pelvic fracture. Methods A total of 117 cases of severe pelvic fracture patients from March 2001 to December 2013 had been divided into two groups according to the treatment principle were whether or not followed by DCO. The observation group（n=69） used DCO， life saving + pelvic external fixation for provisions were implemented， the general condition improved and damage control nursing deterministic processing. The control group（n=48） used early operation treatment and traditional care methods. The differences in lactate clearance time， temperature recovery time， APTT and PT recovery time had been observed between two groups. Compared with the incidence of ARDS， MOF and the number of mutilation， death. Results The recovery time in observation group were significantly reduced（P 0.05）， the incidence of ARDS， MOF and the number of mutilation， death in observation group were lower than the control group with statistical significance（P0.05）. Conclusion Fracture patients using DCO principles of treatment and nursing of severe pelvic， can reduce the serious complications， reduce pelvic fracture morbidity and mortality、improve the quality of life and treatment effect of nursing. 　　[Key words] Damage control； Heavy； Pelvic fracture； Nursing 　　重型骨盆骨折是一种因高能量外力挤压、撞辗或高处坠落所致的不稳定骨折，常合并大出血、腹腔脏器损伤、盆腔脏器损伤、尿道损伤、骨盆骨折及肌肉组