损伤控制性手术在178例以重型颅脑损伤为主的多发伤中的应用  

Application of damage control surgery in treatment of 178 patients with multiple injury mainly manifested as severe craniocerebral injury

作　　者：肖虹[1] 黄警锐[1] 胡唏[1] 许毅[1] 刘科[1] 冯华[2] 

机构地区：[1]重庆市急救医疗中心神经外科,重庆400014 [2]第三军医大学西南医院神经外科,重庆400038

出　　处：《第三军医大学学报》2012年第19期2012-2015,共4页Journal of Third Military Medical University

基　　金：重庆市卫生局医疗特色专科资助项目(渝卫科教[2010]52号)~~

摘　　要：目的探讨应用损伤控制性手术(damage control surgery,DCS)治疗以重型颅脑损伤为主的多发伤的效果。方法 2010-2011年我院178例重型颅脑损伤伴多脏器损伤患者(DCS组)在治疗中贯彻损伤控制外科原则救治,并与2009-2010年我院收治采用常规方法救治的156例重型颅脑损伤伴多脏器损伤患者(非DCS组)死亡率及预后进行比较。结果 DCS组178例患者中136例行开颅血肿清除兼去骨瓣减压术,其他部位损伤分别行专科处理,存活109例(61.2%),死亡69例(38.8%),其中35例死于严重颅脑损伤,21例死于严重胸腹部损伤,13例死于MODS等严重并发症。DCS组和非DCS组患者围手术期死亡率[非DCS组为44.9%(70/156)]差异无统计学意义(P=0.988)。DCS组109例半年后随访GOS评分,恢复良好22例(20.2%),中残47例(43.1%),重残40例(36.7%)。DCS组和非DCS组存活患者恢复良好率[非DCS组为9.3%(8/86)]差异有统计学意义(P=0.037)。结论应用损伤控制外科原则处理以重型颅脑损伤为主的多发伤,合理选择和应用适当的措施,及时终止或减轻损伤导致的致命性脑损害,可提高救治成功率,值得临床重视及推广。study the curative effect of damage control surgery （DCS） on multiple injury mainly manifested as severe craniocerebral injury. Methods One hundred and seventy-eight patients with multiple injury accompanying severe craniocerebral injury underwent DCS in our hospital from 2010 to 2011. Their mortality and prognosis were compared with those of 156 patients with multiple injury accompanying severe craniocerebral injury who underwent conventional treatment （non-DCS treatment） in our hospital from 2009 to 2010. Results Of the 178 patients with multiple injury accompanying severe craniocerebral injury, 136 （76. 4% ） underwent hematoma-removal craniotomy and bone flap-removal decompression. Injuries at other sites were treated in other departments. Of these 136 patients after treatment, 109 （61.2%） survived and 69 （38.8%） died （35 died of severe craniocerebral injury, 21 died of severe thoraco-abdominal injury, and 13 died of severe MODS complications）. The perioperative morality was 38.8% （69/178） and 44.9% （70/156） in DCS treatment group and non-DCS treatment group, respectively （P = 0. 988 ）. The 109 patients in DCS treatment group were followed up for 6 months and scored for GOS. The good recovery, moderate disability and severe disability were found in 22 （20.2%）, 47 （43. I% ） and 40 （36.7%） patients, respectively. The good recovery rate was significantly higher in DCS treatment group than in non-DCS treatment group （20.2% vs 9. 3 %, P -- 0.037）. Conclusion DCS can increase the successful treatment rate for multiple injury accompa- nying severe craniocerebral injury when the measures are appropriately selected and applied in treatment of fatal cerebral injury, and is thus worth of spreading in clinical practice.

关 键 词：损伤控制 重型颅脑损伤 多发伤 手术策略 

分 类 号：R181.32[医药卫生—流行病学] R605[医药卫生—公共卫生与预防医学]