以严重胸腹伤为主多发伤急诊救治.docVIP

以严重胸腹伤为主多发伤急诊救治 　 作者：杨祖清， 付守芝， 张继业， 薛颖， 卜志勇， 李青 【摘要】 目的：评价以严重胸腹伤为主的多发伤的救治经验。方法：对846例严重胸腹伤为主的多发伤患者的临床资料进行回顾性分析。结果：经系统而有重点的检查和积极的抢救，本组846例患者在急诊科死亡106例，病死率12.5％；收入院740例，急诊手术692例，死亡96例，病死率13.9％，其中237例极度危重患者采用损伤控制外科技术，死亡41例，病死率17.3％。结论：及时正确的诊断是救治的前提，提高早期诊断率、合理应用限制性液体复苏和损伤控制外科技术、积极防治并发症，是提高严重胸腹伤为主的多发伤生存率及降低死亡率的关键。 【关键词】 严重胸腹部多发伤； 诊断； 外科治疗 Abstract: Objective To evaluate the emergent rescue for severe Multitrauma of Thorax and Abdomen and the effect of emergent rescue on outcome. Methods The outcomes of 846 patients suffering from severe multiple traumas of thorax and abdomen were retrospectively analyzed. Results Patients were graded according to severity of trauma and actively treated by limited fluid resuscitation, damage control surgery, and prevention of complication, according to their conditions.One hundred thirty-seven cases died in the department of emergency among 846 cases,the mortality was 12.5 percent. Emergent operations were performed on 692 cases in 740 inpatients，96 patients died during or after operation,the operation mortality was 13.9 percent.Two hundred thirty-seven critically ill cases were treated by damagecontrolsurgery,41 cases died,the mortality for these patients was 17.3 percent. Conclusion The early diagnosis and the prompt comprehensive treatment are critical to increase survival rate for severe multiple traumas of thorax and abdomen. Key words:Multiple traumas of thorax and abdomen;Diagnosis;Emergent treatment 严重创伤常为多发伤，伤情复杂，常损伤头、胸、腹部等多个重要脏器，休克发生率高，由于急性血容量减少引起组织低灌流状态及缺氧，伴随全身应激反应及严重生理紊乱，常迅速发生一系列并发症而危及伤员生命，救治难度较大。我科1998年1月-2007年8月共收治严重胸腹伤为主的多发伤846例，其中692例接受了急诊手术治疗，现报告如下。 1 资料与方法 1.1 一般资料 本组846例，男744例,女102例,年龄11～72岁,平均年龄41.6岁。其中11～16岁132例，16～40岁569例,40～50岁112例，50岁以上33例。致伤原因:车祸伤402例(47.5%),高处坠落伤162例(19.1%),压砸伤94例(11.1%),锐器伤87例(10.3%),钝器伤75例(8.9%)，其他26例(3.1%)。 1.2 损伤情况 1.2.1 胸腹部伤情：多发肋骨骨折601例,血气胸527例,气胸149例,血胸103例,肺挫伤或肺挫裂伤487例,膈肌破裂43例,脾破裂532例,肝破裂348例,小肠、结肠及系膜损伤178例,肾挫裂伤294例,胰腺损伤103例,腹膜后血肿167例。入院时胸腹部伤严重程度用AIS判定[1],均≥3分。 1.2.2 合并伤伤情:合并颅脑颈