损伤控制外科理念在高原严重腹部创伤中的应用研究  

Study on application of damage control surgery concept in plateau severe abdominal trauma

作　　者：赵泽文 胡清华 张孝才 宁萃秀[2] ZHAO Zewen;HU Qinghua;ZHANG Xiaocai;NING Cuixiu(115th Central Hospital of Tibet Military Region,Linzhi,Tibet 860000,China;41th Hospital of Tibet Military Region,Shannan,Tibet 856100,China)

机构地区：[1]西藏军区解放军第115中心医院,西藏林芝860000 [2]西藏军区解放军第41医院,西藏山南856100

出　　处：《重庆医学》2018年第35期4497-4499,4503,共4页Chongqing medicine

摘　　要：目的探讨损伤控制外科(DSC)理念在高原严重腹部创伤救治中的应用效果。方法前瞻性分析了2015年1月至2017年12月解放军第115中心医院收治的62例严重腹部创伤患者的临床资料,按照随机数字表法分为对照组和研究组,每组31例。对照组患者接受一次性确定手术治疗,研究组患者接受DCS手术。比较两组患者的受伤情况[包括致伤原因构成比和术前创伤严重度评分(ISS)],术后并发症发生率和病死率,术后恢复情况相关指标[包括休克纠正时间、体温恢复时间、乳酸清除时间、凝血酶原时间(PT)恢复时间、住院时间]。结果患者致伤原因主要为车祸伤和高处坠落伤。研究组患者的致伤原因构成比和术前ISS与对照组比较,差异均无统计学意义(P>0.05)。研究组患者的并发症发生率和病死率均低于对照组,差异有统计学意义(P<0.05)。对照组3例死于成人呼吸窘迫综合征(ARDS),2例死于多器官功能衰竭(MODS);研究组1例死于MODS。研究组患者的术后休克纠正时间、体温恢复时间、乳酸清除时间、PT恢复时间和住院时间均少于对照组,差异有统计学意义(P<0.05)。结论 DCS理念用于高原严重腹部创伤救治,临床效果显著,值得推广应用。Objective To study the application effects of damage control surgery(DSC)concept on the treatment of severe abdominal trauma in plateau region.Methods The clinical data of 62 patients with severe abdominal trauma admitted to 115 Central Hospital of PLA from January 2015 to December 2017 were prospectively analyzed.According to the random number table method,they were divided into the control group and study group,31cases in each group.The patients in the control group received one-time definite surgical treatment,and the patients in the study group received DCS.The injury status(including the composition ratio of injury causes and preoperative ISS score),incidence rate of postoperative complications and mortality,postoperative recovery related indicators(including shock correction time,body temperature recovery time,lactate clearance time,prothrombin time(PT)recovery time,hospital stay)were compared between the two groups.Results The main causes of injury were car accident injuries and fall injuries from high places.There were no significant differences in the composition ratio of injury causes and the preoperative ISS score between the study group and control group(P>0.05).The incidence rate of complications and mortality in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).In the control group,3 cases died of adult respiratory distress syndrome(ARDS),and the 2 cases died of multiple organ failure(MODS).One case in the study group died of MODS.The postoperative shock correction time,body temperature recovery time,lactic acid clearance time,PT recovery time,and hospital stay in the study group were less than those in the control group,and the differences were statistically significant(P<0.05).Conclusion The application of DCS concept in the treatment of severe abdominal trauma in plateau region can produce the remarkable clinical effects and is worth popularizing and applying.

关 键 词：损伤控制外科 高原病 腹部损伤 治疗结果 

分 类 号：R641[医药卫生—外科学]