肝爆震伤的救治 - 灾害医学与救援（电子版）.pdf

∙69 ∙ 灾害医学与救援（电子版）2015 年5 月 第4 卷 第2 期 Disaster Medicine and Rescue (Electronic Edition) ,Vol.4,No.2,May,2015 肝爆震伤的救治肝爆震伤的救治 牟洪超，周 辉，姜小清，蔡 岩，孙 茂，董立军 [[摘摘要要]] 目的目的：：探讨肝爆震伤的临床救治模式。方法方法：：回顾性分析我科1998年5月—2013年12月期间收治的18例肝爆 震伤病例的临床资料，总结致伤原因、机制、多发伤的情况以及临床救治方法和经验，探讨研究肝爆震伤的急救模式。结果结果：：18例肝 爆震伤中属于高压锅爆炸所致1例，煤气罐爆炸致伤3例，烟花爆竹爆炸致伤6例，矿井瓦斯爆炸致伤8例。其中14例是伤后 30min～4h内入院，另外4例在外院行初步处理后于伤后8h内转至我院。全组病例入院后均明确肝爆震伤和多发伤的诊 断。本组18例均存在不同程度休克，无单纯肝爆震伤病例，均存在不同的多发伤，其中不同程度烧伤11例（5例伴吸入性损 伤）、开放性骨折2例、肺爆震伤7例、脾破裂2例、胰腺挫裂伤1例、肠管挫裂伤3例。全部病例在院前均给予了基本的止血，创 面包扎、固定，气胸抽气，吸氧，抗休克等治疗，入院后18例中行非手术治疗6例，6例痊愈，治愈率100％（6/6），手术治疗12例， 治愈11例，治愈率91.7％，死亡1例，病死率8.3％。结论结论：：院前紧急救治、后送、院内救治这种无间断的救治链条模式对肝爆 震伤患者的抢救至关重要；肝爆震伤患者的术式选择应同常规伤区别；重视多发伤的治疗。 [[关键词关键词]] 肝爆震伤；临床救治；急救模式 [[中国图书分类号中国图书分类号]] R 657.32 [[文献标识码文献标识码]] A [[文章编号文章编号]] 2095-3496（2015）02-0069-05 TreatmentTreatment ofof liverliver blastblast injuryinjury MOU Hong-chao ，ZHOU Hui ，JIANG Xiao-qing ，CAI Yan，SUN Mao，DONG Li-jun.Department of Hepa- tobiliary Surgery.404 central hospital of PLA. Shandong，Weihai 264200 ，China [Abstract][Abstract] ObjectiveObjective：：To investigate the clinical treatment mode of liver blast injury. MethodsMethods ：：The clinical data of 18 patients with liver blast injury who had been treated in our department from May 1998 to December 2013 were studied retrospectively. We summarized the causes of injury, mechanisms，merger injury and compound injury as well as clinical treatment methods and experi- ence to explore the emergency mode of liver blast injury. ResultsResults ：：Wthin 18 cases of liver burst injury, there are pressure cooker ex- plosion ( 1 case)，gas tank explosion (3 cases)，fireworks explosion (6 cases), mine gas explosion (8 cases). 14 cases were in hospital- ized immediately within 30minutes-4hours after injury ，another 4 cases undergoing initial treatment in other hospital were hospital- ized after t