严重多发伤ICU期间的外科救治策略  

Surgical treatment strategy for severe multiple injuries in intensive care unit

作　　者：张连阳[1] 姚元章[1] 黄显凯[1] 蒋东坡[1] 周健[1] 黄健[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所全军战创伤中心创伤、烧伤与复合伤国家重点实验室,重庆400042

出　　处：《中国急救复苏与灾害医学杂志》2010年第8期703-706,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：全军医学卫生科研基金专项课题（08Z024）

摘　　要：目的探讨严重多发伤ICU期间的外科救治策略。方法回顾性分析ICU收治的严重多发伤163例，男118例，女45例；年龄36．2（5～67）岁，致伤原因包括交通事故伤、刀刺、坠落、工程事故伤；损伤部位包括头颈、面部、胸、腹、骨盆及四肢、体表。合并休克57例。损伤严重程度评分（xss）18．42分（10～54分）。结果ICU收治期间28例行外科诊疗操作，48例外科救治，24h内10例、24—48h内8例、3～7d内7例、8～14d手术23例。163例ICU收治时间7．56d（2—29d）。治愈143例（87．73％）；院内死亡11例（6．75％），死亡原因包括严重失血性休克、严重颅脑伤、多脏器衰竭。自动出院后死亡9例。总死亡率12．27％。结论严重多发伤ICU复苏期间应遵循损害控制原则，外科救治策略包括积极控制出血，处理前期遗漏的损伤，处理相关的创伤或手术并发症，实施计划性分期手术．Objective To explore the surgical treatment strategies for severe multiple injury in intensive care unit （ICU）. Methods The clinical data of 163 patients with severe multiple injury in head and neck, face, chest, abdomen, pelvis and limbs ,or body surface, caused by traffic accident, knife stab, falling and engineering accidents with the injury severity score of 18.45, treated in ICU, 118 males and 45 females, aged 36.2 （5-67）, 57 with shock, were analyzed. Results Early diagnosis was emphasized in time,and nace ssary operation was performed immediately. The duration of treatment in ICU was 7.56 days （2-29 days）. Twenty-eight patient-times underwent surgical diagnostic procedures, and 48 patient-times underwent surgical treatment, I0 case-times within 24 hours, 8 case-times within 24-48 h, 7 case-times within 3-7 days, and 23 case-times within 8-14 days. Among these patients, 143 were cured （87.73%） and 11 died in the hospital （6.75%） due to severe hemorrhagic shock, craniocerebral injury, or multiple organ failure. Nine patients died after voluntarily leaving hospital. The total mortality was 12.27%. Conclusion The principle of damage control should be observed in resuscitation in ICU. The surgical treatment strategies for severe multiple injury in ICU include： active control of hemorrhage, treatment of injuries omitted in previous treatment, treatment of related wounds or surgical complications and performance of planned staging operation.

关 键 词：多发伤 ICU 外科治疗 

分 类 号：R64[医药卫生—外科学]