损伤控制性手术对严重腹部损伤患者救治.docVIP

损伤控制性手术对严重腹部损伤患者救治[摘　要]　目的：探讨对严重腹部损伤患者实施损伤控制性手术的方法及策略，从而提高创伤的抢救成功率。方法：对72例腹部损伤患者进行初步急救处理后，按照ISS创伤评分，对ISS评分≤16的患者实施I期确定性手术，对ISS评分＞16的患者实施损伤控制原则，采取分期处理：应急简化手术、ICU复苏、实施II期确定性手术。结果：72例腹部损伤患者均进行了剖腹探查术，临床治愈68例（94.44%）。对11例严重腹部外伤患者实施DCO，应急简化手术处理止血均成功，行II期计划性手术；II期手术后1例出现肝脓肿，2例出现胆瘘，1例出现隔下感染，经抗炎及引流痊愈；4例患者死亡。结论：对于符合DCO指针的严重腹部损伤患者，实施DCO可以减少并发症，并提高患者的救治成功率。 [关键词]　严重腹部外伤；损伤控制手术 [Abstract] Objective： serious abdominal injury patients to implement damage control strategies and methods of operation, so as to improve the trauma of the rescue the success rate. Methods :72 cases of patients with abdominal injury preliminary emergency treatment, according to ISS trauma score, the ISS score of patients than 16 implementation stage I certainty surgery, to score 16 patients ISS implement damage control principle, deal with by stages: the emergency resuscitation, simple operation, ICU implementation phase II certainty surgery. Results: 72 cases of patients with abdominal injury are subject to a perirenal abscess, clinical cure 68 cases (94.44%). On 11 cases with severe abdominal trauma patients implementation DCO, emergency surgical treatment are simplified bleeding success, line phase II planning operation; Phase II surgery in 1 appear liver abscess, 2 cases appear bile leak, 1 case appears between the infection, the anti-inflammatory and drainage well; Four patients died. Conclusion :in accordance with the serious DCO pointer abdominal injury patients, implement DCO can reduce complications, and improve the treatment of patients with success rate. [Key Words] severe abdominal trauma Damage control operatio 损伤控制性手术（damage control operation，DCO）[1]是一种主要针对腹部创伤复杂的应急分期手术的理念，是近年来外科领域中既有价值的外科原则。我们将损伤控制理念引入多发伤救治工作中，取得良好效果。 1　临床资料 1.1一般资料　自2005年1月～2010年12月，我们收治72例多发伤合并腹部损伤患者。男47例，女25例；年龄17～70岁；按照ISS创伤评分为6～58分，其中≤16分61例，＞16分11例；车祸伤50例，坠落伤9例，挤压伤6例，刀刺伤4例，爆炸伤3例；腹部闭合伤46例，腹部开放损伤26例；入院时轻度休克29例，中度休克37例，重度休克6例。损伤至手术时间为30min～22h。 1.2损伤部位　72例患者腹内损伤情况：肝脏损伤29例，后腹膜血肿20例，脾脏损伤34例，胰腺损伤12例，胃损伤18例，十二