损伤控制性复苏在严重肝外伤治疗中的应用  

The application of damage of damage control resuscitation in the treatment of severe hepatic trauma

作　　者：田志强 罗昆仑 余锋 方征 刘洪 

机构地区：[1]解放军第一零一医院肝胆外科,无锡214044

出　　处：《肝胆外科杂志》2014年第3期199-202,共4页Journal of Hepatobiliary Surgery

基　　金：全军医药卫生科研基金资助项目(10MA008)

摘　　要：目的 探讨损伤控制性复苏在严重肝外伤救治中的临床疗效.方法 回顾性分析2003年1月～ 2013年6月收治的116例严重肝外伤患者的临床资料,其中A组57例采用传统液体复苏救治,B组59例采用损伤控制性复苏救治.损伤控制性复苏包括：允许维持较低血压,红细胞、血浆与血小板按比例输入,早期采取保温措施,积极纠正酸中毒.比较2组间ICU复苏前后乳酸水平、pH值、体温、PT值、INR值等指标,以及并发症发生率和死亡率变化.结果 ICU复苏前,2组患者乳酸水平、pH值、体温、PT和INR值等指标比较差异无统计学意义（P＞0.05）.ICU复苏期,2组PH值、体温较复苏前升高,且B组升高较A组明显（P＜0.05）;乳酸水平、PT和INR值较复苏前降低,且B组降低较A组明显（P＜0.05）.B组并发症发生率和死亡率均低于A组,差异有统计学意义（P＜0.05）.结论 损伤控制性复苏是严重肝外伤救治的较好方法,能够减少并发症发生,降低死亡率.Objective To investigate the utilization of damage control resuscitation （DRC） in the treatment of the severe hepatic trauma. Methods The clinical data of 116 patients of severe hepatic trauma admitted from January 2003 to June 2013 were retrospectively analyzed. A group of 57 eases were treated with conventional fluid resuscitation, B group of 59 patients were treated with DCR. DCR combines two seemingly diverse strategiespermissive hypotension and haemostatic resuscitation-with damage control sur gery. Compare the difference of lactate levels, pH, temperature, prothrombin time （PT）, international normalized ratio （INR） before and after resuscitation, complications and mortality between the two groups. Results There were no significant differences in the lactate levels, pH value, body temperature, PT and INR between two groups （ all P 〉 0. 05 ）. Conclusion DCR is a better treatment strategy for patients with severe hepatic trauma, can reduce complications and mortality.

关 键 词：肝外伤 损伤控制性复苏 创伤和损伤 

分 类 号：R575[医药卫生—消化系统]