腹部创伤150例急救分析  

Emergency Treatment of Abdominal Trauma:Report of 150 Cases

作　　者：胡琳[1,2] 赵景明[1,2] 李文东[1,2] 毕敬涛[1,2] 郭晏同[1,2] 

机构地区：[1]北京积水潭医院 [2]北京大学第四临床医学院普通外科,北京市100035

出　　处：《中国全科医学》2012年第26期3055-3057,共3页Chinese General Practice

摘　　要：目的总结腹部创伤急救的经验,提高急救水平。方法回顾分析我院2002年1月—2011年8月收治的腹部创伤患者150例,总结分析其损伤情况、临床救治、术后并发症及预后。结果本组150例腹部创伤患者致伤原因主要有交通事故75例、坠落伤25例、锐器伤21例、挤压伤18例等。损伤部位以脾脏57例、小肠43例、肾脏28例、肝脏24例为主。同时合并胸部损伤58例、骨盆骨折38例、颅脑损伤19例、脊柱骨折19例、四肢骨折及全身软组织损伤73例。腹腔2个及以上脏器损伤53例。损伤严重度(ISS)评分:6～50分,平均21分,其中ISS评分16～24分(重伤)26例,ISS评分≥25分(危重伤)26例。快速行心电图、血氧饱和度、呼吸、血压监测,完善相关检查后,行非手术治疗53例,手术治疗97例。术后并发症:感染中毒性休克5例、成人呼吸窘迫综合征(ARDS)4例、多器官功能衰竭(MODS)3例、弥散性血管内凝血(DIC)1例;腹腔感染3例;切口感染6例、切口脂肪液化4例、切口裂开2例;胸腔积液3例、肺部感染2例、肺不张2例;肠瘘1例。7例患者死亡,死亡率为4.7%。3例自动出院。结论腹部创伤患者病情复杂、危重,救治应争分夺秒,选择敏感检查方法,早期制定治疗方案,随病情变化修订治疗方案,有利于提高治愈率,降低并发症发生率和死亡率。Objectives To summarize the experience of emergency treatment of abdominal trauma to improve its di- agnosis and treatment. Methods A retrospective study was carried out on 150 abdominal trauma patients admitted to Jishuitan hospital from January 2002 to August 2011. Results The main injury causes were traffic accident, falling injury, sharp instru- ment injury, crush injury etc. The main injured parts were spleen, small intestine, kidney, liver, colon, bladder, some con- comitant with thoracic injury, pelvic fracture, brain injury, spinal fracture, limb fracture and systemic soft tissue trauma. Fifty - three patients had more than 2 abdominal organ injuries. Injury severity scores （ISS） were 6 ~ 50, mean 21.2, including 26 patients with ISS16 -24 （serious injury）, 26 with ISS ~〉25 （critical injury with a high mortality）. After rapid ECG, blood ox- ygenation, monitoring of respiratory and blood pressure, other examinations, 53 patients received nonoperative management, 97 received operative. Postoperative complications included septic shock （5 cases）, ARDS （4 cases）, MODS （3 cases）, DIC （1 case）, abdominal infection （3 cases）, incision infection （6 cases）, incision fat necrosis （4 cases）, disruption of wound （2 cases）, pleural effusion （3 cases）, pulmonary infection （2 cases）, pulmonary atelectasis （2 cases）, intestinal fistula （1 case）. Seven patients died （ 4. 7% ）. Three patients were discharged. Conclusions Abdominal trauma patients having com- plex, critical condition must be rescued rapidly. Choice of sensitive examinations, early determination of treatment protocols and its revise according to condition changes are benefit to improvement of cure rate, reduce mortality and complication incidence.

关 键 词：腹部损伤 创伤和损伤 急救 

分 类 号：R264[医药卫生—中医外科学]