创伤性截肢的流行病学特征及其一种常见原因 （创面血管破裂）的临床分析-外科学专业论文.docxVIP

目 录 中文摘要··········································································································1 英文摘要··········································································································4 英文缩写··········································································································6 研究论文 创伤性截肢的流行病学特征及其一种常见原因（创面血管破裂） 的临床分析 前言··········································································································7 材料与方法······························································································8 结果··········································································································10 附表··········································································································13 讨论··········································································································19 结论··········································································································26 参考文献··································································································27 综述 肢体损伤严重程度评估方法与预测截肢的回顾及体会··················30 致谢··················································································································46 个人简历··········································································································47 创伤性截肢的流行病学特征及其一种常见原因（继发性创面出血） 的临床分析 摘 要 目的：截肢作为创伤后的严重并发症，无论是对临床工作者还是患者 及其家属，都是一项巨大的挑战，临床工作者应对其有全面而客观的了解。 而创伤后创面出现的大出血则是导致截肢的重要原因之一，应引起临床工 作者的重视，在出现此类并发症时积极有效地进行处理。为此，我们对此 类患者的病历进行了详尽的回顾性研究，旨在对临床工作作出指导。 方法：对 2009 年 1 月至 2013 年 12 月期间河北医科大学第三医院收 治的由于创伤导致的截肢患者以及 2006 年 1 月至 2013 年 7 月我院收治的 严重软组织损伤后出现创面血管破裂并发生急性大出血的患者的病历资 料进行回顾性调查。 利用我院病案查询系统调取创伤性截肢患者的病历资料，由 6 名经过 统一培训的医护人员按设计要求进行资料查询和收集。首先设计调查表， 随机选取 30 份病例进行预调查，并根据调查结果对调查表的内容进行修 改，最终确定的调查项目包括：年龄、性别、受伤机制、损伤类型、损伤 程度、伤后就诊时间、手术次数、住院天数、以及截肢的时机、部位、原 因等。损伤程度的评估：对开放性损伤患者使用 Gustilo 分型和 MESS 评 分；对于闭合性损伤，由于缺乏客观的评价方法，且损伤程度难以界定， 因此主要采取描述性语