49例严重肢体挤压伤院前院内一体化救治  

Pre-hospital and in-hospital integrated treatment for severe crush injuries of extremities: experience in 49 cases

作　　者：王建柏[1] 高劲谋[1] 胡平[1] 杨俊[1] 林曦[1] 黄光斌[1] 何平[1] 艾涛[1] 向江侠[1] 都定元[1] 

机构地区：[1]重庆市急救医疗中心重庆市急救医学研究所创伤外科,重庆400014

出　　处：《创伤外科杂志》2016年第7期393-396,共4页Journal of Traumatic Surgery

基　　金：国家"十二五"科技支撑计划资助项目(2012BAI11B01);重庆市科委自然科学基金重点资助项目(2012jjB10021);重庆市卫生局医学科学技术研究重点资助项目(2010-1-52;2011-2-378)

摘　　要：目的探讨严重肢体挤压伤的院前院内一体化救治方法和效果。方法回顾性分析2008年5月~2015年7月收治的严重肢体挤压伤患者49例的院前院内一体化救治的临床资料,男性44例,女性5例;年龄19~82岁,平均43.7岁。地震伤5例、道路交通伤20例、工矿事故伤17例、其他7例。受伤肢体:肩背上肢8例、骨盆及下肢41例。合并骨盆及肢体骨折脱位32例(闭合伤20例,开放伤12例),多发伤44例。结果院前救援时间35min^49h,现场救援建立静脉通道并输液19例,止血带使用31例。全部病例在解压后行心电监测,救援现场行小腿筋膜室切开1例,膝关节离断1例。院内救治包括清创后负压封闭引流14例,筋膜室切开减压后负压封闭引流17例,负压引流有效率96.8%(30/31),使用负压引流组无截肢者;发生挤压综合征28例(57.1%),其中合并高钾血症11例,肾功能衰竭8例;使用呼吸机辅助治疗8例,连续性肾替代治疗8例。治愈31例;好转13例;未愈5例,包括截肢3例(6.1%),死亡1例(2.0%),死因为高钾血症致心肺复苏失败。结论重视止血带和心电监测在严重肢体挤压伤院前救援中的应用,实施负压封闭引流技术可减少严重肢体挤压伤的截肢率。Objective To evaluate the therapeutic methods and effect of pre-hospital and in-hospital integrated treatment for severe crush injuries of extremities. Methods The clinical data of 49 patients with severe crush injuries of extremities from May 2008 to Jul. 2015 in Chongqing Emergency Medical Center was retrospectively studied. There were 44 males and 5 females,with age ranging from 19 to 82 years（ average,43. 7 years）. There were 5 cases of earthquake injury,20 cases of traffic accident injury,17 cases of mining accident injury,and 7 cases injured by other causes. Injured sites of crushes were as follows： shoulder and upper limbs in 8 cases（ 16. 3%）,pelvic and lower limbs in 41 cases（ 83. 7%）. Thirty-two cases（ 65. 3%） were associated with fractures and dislocation of pelvis and joints,and 44 cases were associated with multiple injuries（ 89. 8%）. Results Pre-hospital time was 35min-49 h. Venous pathway was established and infusion was applied in 19 cases during on-the-scene rescue and tourniquet was applied in 31 cases（ 63. 3%）. Decompressive fasciotomy was performed in 1 case and amputation was performed in 1 case during on-the-scene rescue. Electrocardiogram monitoring was performed in all cases after decompression. In-hospital therapeutic measures included vacuum sealing drainage（ VSD） in 14 cases after debridement and 17 cases with decompressive fasciotomy. The effective rate of VSD was 96. 8%（ 30 /31） and no case was amputated in this group. The incidence rate of crush syndrome（ CS） was 57. 1%（ 28 /49）,of which 11cases（ 22. 4%） were combined with hyperkalemia,and 8 cases with renal failure. Eight cases were treated with ventilator assisted therapy and 8 cases were treated with continuous renal replacement therapy（ CRRT）. At the end,31 cases（ 63. 3%） were cured,13 cases（ 26. 5%） were improved,and 5 cases（ 10. 2%） were uncured,which included 3 cases（ 6. 1%） of amputation and 1 death case（ 2. 0%） died from failed cardiopulmonary resuscitation

关 键 词：肢体损伤 挤压伤 一体化救治 截肢 

分 类 号：R642[医药卫生—外科学]