严重腹部创伤在SICU及综合ICU加强治疗.docVIP

严重腹部创伤在SICU及综合ICU加强治疗 　【摘要】 目的 探讨严重腹部创伤在SICU和综合ICU用AIS-ISS评分的意义，对全身多种生理功能及生化指标等进行重症监测和加强治疗的体会。方法 回顾分析1996～2003年在SICU和综合ICU治疗严重腹部创伤72例。其中合并多发伤占66.66％。仅有腹部创伤AIS均≥3分，多发伤ISS的分值≥16分的占87.25％，对以上病例做相应手术处理后住SICU，需呼吸机支持呼吸或血流动力学不稳定的住综合ICU，给予循环、呼吸等多种监测仪的监测和加强治疗及高质量的护理。结果 治愈64例，死亡8例，死亡率11.11％。其中早期死亡4例，是合并严重颅脑损伤、急性呼吸窘迫综合征（ARDS）；中期死亡4例是因腹腔感染、肺部感染、全身炎症反应综合征（SIRS）及多器官功能障碍综合征（MODS）。结论 （1）迅速查明受伤部位及器官，用AIS-ISS评估其损伤的严重程度，优先处理危及生命的部位伤。（2）充分发挥ICU各监测仪的优势，给予高质量的护理，在重要脏器功能出现异常的早期及早发现并予以纠正，可减少并发症及病死率。 【关键词】 腹部外伤；重症监测治疗室；治疗 【Abstract】 Objective Significance of AIS-ISS point system application severe trauma of abdomen in SICU and synthetic ICU， experience of intensive observation and strengthened therapy to general multi-physiology and biochemistry.Methods Totally seventy-two severe trauma of abdomen cases were studied treated in SICU and synthetic ICU from 1996 to 2003 in which 66.66% were complicated by multiple injuries. Some cases only had trauma of abdomen with AIS≥3， and multiple injuries with AIS≥16 was about 87.25%. Patients were settled in SICU after proper operations. Some patients， settled in synthetic ICU， were monitored by multiple monitoring instruments such as circulation and respiration， in the meantime， underwent strengthened therapy and high-grade nurse， if they had to depend on breathing machine or had instable hemodynamic.Results 64 cases cured， 8 cases died，with fatality rate of 11.11% in which 4 cases died early because of complicated by severe craniocerebral injury and ARDS， 4 cases died in the middle time because of abdominal infection， lung infection， SIRS and MODS.Conclusion (1)Find out the injured part and organ， evaluate severity of trauma using AIS-ISS， and firstly treat the trauma which may endanger life.(2)The advantage of the monitoring instrument in ICU shall be fully utilized with high-grade nurse. Complication and fatality rate will be decrease on condition that the abnormity of important organ could be found and treated without any delay. 【Key words】