损伤控制性手术治疗肝破裂出血的临床效果观察  

The clinical effect of damage control surgery in the treatment of hepatorrhexis hemorrhage

作　　者：丁剑锋[1] 黄中伟[1] 徐红梅[1] 

机构地区：[1]南通大学附属医院急诊外科,江苏南通226001

出　　处：《中国医学前沿杂志（电子版）》2016年第10期83-86,共4页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：江苏省南通市科技项目(MS32015032)

摘　　要：目的通过回顾性研究评估损伤控制性手术治疗肝破裂出血的临床效果。方法选取本院2011年1月至2015年12月收治的100例肝破裂出血患者为研究对象,根据美国创伤外科学会-器官损伤分级(American Association for the Surgery of Trauma-Organ Injury Scale,AAST-OIS)标准,入选患者分级均等于或大于Ⅲ级。根据治疗方法不同将其分为对照组(58例)与观察组(42例)。对照组患者采取一期确定性手术,观察组患者采取损伤控制性手术,比较并分析两组患者的治疗效果和并发症发生率。结果 100例肝破裂出血患者中,20例(20%)为AAST-OISⅢ级,24例(24%)为AAST-OISⅣ级,56例(56%)为AAST-OISⅤ级。对照组患者存活28例,死亡30例,死亡率为51.72%;观察组患者存活37例,死亡5例,死亡率为11.90%;两组比较差异具有显著性(P<0.05)。对照组患者严重并发症发生率为51.72%(30/58),观察组为38.10%(16/42),两组比较差异具有显著性(P<0.05)。单因素分析显示,肝破裂出血患者死亡的预测因素分别为:AAST-OISⅤ级(P=0.019),凝血酶原时间延长(P=0.004),活化部分凝血活酶时间延长(P<0.0001),血小板计数下降(P=0.005)。结论即使采取了一期确定性手术,肝破裂出血仍具有较高的死亡率。损伤控制性手术可以降低肝破裂出血患者的死亡率和并发症发生率,具有较好的治疗效果。Objective Performing retrospective study to assess the clinical efficacy of damage control surgery in the treatment of hepatorrhexis hemorrhage. Method A total of 100 patients with hepatorrhexis hemorrhage in our hospital from January 2011 to December 2015 were recruited in this study. According to American Association for the Surgery of Trauma-Organ Injury Scale （AAST-OIS）, all enrolled patients were equal to or higher than grade III. According to different treatment methods, patients were divided into control group （n = 58） and observation group （n = 42）. Patients in control group underwent definitive surgery, patients in observ- ation group underwent damage control surgery. The clinical outcomes and incidence of complications were compared and analyzed between the two groups. Result Among 100 patients with hepatorrhexis hemorrhage, 20 cases （20%） were classified as AAST-OIS III; 24 cases （24%） were classified as AAST-OIS IV; 56 cases （56%） were classified as AAST-OIS V. Among the 58 patients of control group, 28 patients survived, 30 patients died, the mortality rate was 52%; among the 42 patients of observation group, 37 patients survived, 5 patients died, the mortality rate was 11.90%, there were significant differences between the two groups （P 〈 0.05）. Among the 58 patients of control group, 30 patients developed serious complications, the incidence rate was 51.72%; among the 42 patients of observation group, 16 patients developed serious complications, the incidence rate was 38.10%, there were significant differences between the two groups （P 〈 0.05）. Univariate analysis showed that predictors of death were AAST-OIS V （P = 0.019）, prolongation ofprothrombin time （PT） （P = 0.004） and activated partial thromboplastin time （APTT） （P 〈 0.0001）, and declination of platelet count （P = 0.005）. Conclusion Even with a definitive surgery, hepatorrhexis hemorrhage has a higher mortality rate. Damage control surgery for hepatorrhexis hemorrhage can reduce

关 键 词：损伤控制性手术 肝破裂 出血 

分 类 号：R657.32[医药卫生—外科学]