521例腹部创伤的救治分析  

Diagnosis and treatment of 521 cases of abdominal trauma

作　　者：赵山红[1] 高劲谋[1] 胡平[1] 艾涛[1] 薛兴森[1] 余佳宴 

机构地区：[1]重庆市急救医疗中心创伤科,400014

出　　处：《重庆医学》2015年第6期769-771,774,共4页Chongqing medicine

摘　　要：目的总结腹部创伤救治经验。方法回顾性分析2005年6月至2012年5月该院收治的521例腹部创伤患者临床资料。结果 521例腹部创伤患者损伤严重度（ISS）评分8~65分,平均23.6分。钝性伤453例,穿透伤68例。入院时休克231例（44.3%）。腹内损伤脏器777例次。腹部创伤手术率83.5%。合并多发伤331例。死亡34例（6.53%）中,平均ISS评分43.6分,死因为失血性休克13例：肝脏伤大出血7例,腹内大血管伤4例,肺门血管伤2例;颅脑伤7例;心脏4例;胸腔严重感染致ARDS 3例;术后腹腔间室综合征（ACS）1例;术后全身炎症反应综合征（SIRS）和多器官功能不全综合征（MODS）9例。存活者中与腹部创伤相关并发症发生率12.3%（60/487）,主要为感染和出血。结论凡腹腔完整性被破坏均应手术探查;紧急情况下采用损伤控制原则（DCS）而不强求依据器官损伤分级决定手术方案;急诊室剖腹可提高腹内大血管伤救治成功率;重视＂致死三联征＂前兆,在其发生时应迅速终止手术。Objective To investigate the experience of management of abdominal injuries.Methods The data of 521 cases with abdominal injury from June 2005 to May 2012 was analyzed retrospectively.Results In 521 cases,the grade of ISS within 8-65,average 23.6.453 suffered from blunt injuries and 68 from stab penetrating injuries.Hemorrhagic shock appeared in 231patients（44.3%）.The abdominal viscera injuries occurred in 777 cases.The operability of abdominal injuries was 83.5%,associated with polytrauma in 331.The mortality rate was 6.53%（34/521）,in death group,the grade of ISS on average 43.6.13 cases died of hemorrhagic shock,and 7died of severe craniocerebral injury,4died of cardiac injuries,3died of ARDS due to flail chest and Severe pulmonary infection,one died of ACS and nine died of SIRS and MODS.The incidence rate of complication related to abdominal injury was 12.3%（60/487）,most of them was infection and bleeding.Conclusion All that abdominal integrity be destroyed should be explored;use of damage control surgery（DCS）and do not importune to decide to surgery on the basis of organ damage grading in emergency;perform laparotomy could improve the treatment success rate of abdominal large vessels injury in the emergency room;pay attention to the ＂lethal triad＂ precursor,and terminate the operation quickly when it happens.

关 键 词：腹部损伤 外科 手术 手术期间 

分 类 号：R641[医药卫生—外科学]