损害控制理论中负压封闭引流技术预防多器官功能障碍综合征的作用  

Application of vacuum sealing drainage for prevention and treatment of multiple organ dysfunction syndrome

作　　者：杨帆[1] 胡耑[1] 白祥军[1] 田利华[1] 周锡渊[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院创伤外科,武汉430030

出　　处：《中华临床医师杂志（电子版）》2010年第12期74-77,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨多发伤伴严重皮肤软组织损伤救治中,综合应用损害控制理论和负压封闭引流术对多器官功能障碍综合征(MODS)的防治。方法随机筛选出94例伴有严重皮肤软组织损伤的多发伤患者,分为试验组(56例)和对照组(38例),试验组一期采用简略手术,止血、清除坏死组织后急诊行负压封闭引流(VSD)术,待复苏和病情稳定后再行确定性手术;对照组一期采用确定性手术,术后进行复苏和后续诊疗。分析两组间"首次打击"和"二次打击"指标的差异和同MODS和预后的关联。结果试验组术后的体温、休克、酸中毒、凝血功能、全身炎症反应综合征、感染、脓毒症等评价指标的结果显著优于对照组(P<0.05);试验组致死性三联征(LTD)发生率为14.29%,MODS发生率为7.14%,7d内死亡率为0,7d后死亡率为1.79%,均显著低于对照组(P<0.01)。结论综合应用损害控制理论和负压封闭引流术,可防止患者生理功能进一步紊乱衰竭,同时吸附坏死组织和创面渗出物,对防治感染、MODS和降低死亡率具有显著效果。Objective To investigate integrate control of multiple organ dysfunction syndrome （MODS） by the damage control theory and vacuum sealing drainage operation. Methods Ninty-four cases of multiple traumatic patients with serious skin and soft tissue injury were randomly sampled and divided into study group（56 cases）and control group（38 cases） ,then the variance of primary strike and secondary strike related to the MODS and prognosis between two groups were analyzed. Results The body temperature, shock, acidosis, blood clotting function, systemic inflammatory response syndrome, infection and sepsis were significant improved than those in control group（ P 〈 0. 05 ）, incidence rate of LTD, MODS and mortality rate within and after 7 days were 14. 29% ,7.14%, 0 and 1, 79% respectively, and significant lower than those in control group （P 〈 0.01 ）. Conclusions Integrate control by damage control theory and vacuum sealing drainage operation could prevent physiological function getting worse, drainaged necrotic tissue and raw surface effusion. It＇s helpful us to prevent and treat the infection to avoid MODS and reduce the mortality rate.

关 键 词：多器官功能衰竭 负压伤口疗法 多处创伤 损害控制理论 

分 类 号：R459.7[医药卫生—急诊医学]