暂时性腹主动脉阻断在严重腹部外伤大出血手术中的应用效果  

Application effect of temporary occlusion of abdominal aorta in operation for severe abdominal trauma and massive hemorrhage

作　　者：韦向京 陈兆菁 吴丽英 韦彪 周启军 韩佳 WEI Xiang-jing;CHEN Zhao-jing;WU Li-ying;WEI Biao;ZHOU Qi-jun;HAN Jia(Department of General Surgery,the First People′s Hospital of Hechi,Hechi 546300,China)

机构地区：[1]广西河池市第一人民医院普通外科,河池市546300

出　　处：《广西医学》2020年第16期2080-2083,共4页Guangxi Medical Journal

基　　金：广西医药卫生科研课题(Z2014344)。

摘　　要：目的探讨暂时性腹主动脉阻断在严重腹部外伤大出血手术中的应用效果。方法回顾性分析160例行手术治疗的严重腹部外伤大出血患者的临床资料,其中观察组(82例)术中采用暂时性阻断腹主动脉技术,对照组(78例)术中采用常规止血方法。比较两组患者的手术时间、术中出血量、术后气管插管机械通气时间、术后住院时间等指标,以及术毕即刻死亡三联征(低体温、代谢性酸中毒和凝血功能障碍)和高乳酸血症的发生率,观察两组患者术后并发症发生率、再次剖腹率、病死率和治愈率。结果观察组术中出血量、手术时间、术后机械通气时间、术后住院时间均少于或短于对照组,术后即刻死亡三联征和高乳酸血症的发生率,以及术后并发症发生率、再次剖腹率和病死率均低于对照组,治愈率高于对照组(均P<0.05)。结论严重腹部外伤大出血患者术中采用暂时性腹主动脉阻断技术可缩短手术时间及术后气管插管机械通气时间,减少术中出血量,降低死亡三联征、高乳酸血症和术后并发症的发生率及病死率,提高治愈率。Objective To investigate the application effect of temporary occlusion of abdominal aorta in the operation for severe abdominal trauma and massive hemorrhage.Methods The clinical data of 160 patients undergoing surgical treatment for severe abdominal trauma and massive hemorrhage were retrospectively analyzed,82 patients in the observation group received temporary occlusion of abdominal aorta during operation,whereas 78 patients in the control group received routine hemostasis therapy during operation.The two groups were compared with respect to operation duration,intraoperative blood loss,duration of postoperative mechanical ventilation using tracheal intubation,postoperative hospital stay and other indices,as well as incidence rates of lethal triad instantly after operation(hypothermia,metabolic acidosis and coagulation dysfunction)and hyperlactacidemia,and the incidence rate of postoperative complications,re-laparotomy rate,case fatality,and cure rate were observed in the two groups.Results Compared with the control group,the observation group had less intraoperative blood loss,shorter operation duration,shorter duration of postoperative mechanical ventilation,and shorter postoperative hospital stay,lower incidence rates of lethal triad instantly after operation and hyperlactacidemia,lower incidence rate of postoperative complications,lower re-laparotomy rate,lower case fatality,and higher cure rate(all P<0.05).Conclusion For patients with severe abdominal trauma and massive hemorrhage,the use of intraoperative temporary occlusion of abdominal aorta can shorten operation duration and duration of postoperative mechanical ventilation using tracheal intubation,reduce intraoperative blood loss,decrease incidence rates of lethal triad,hyperlactacidemia and postoperative complications together with case fatality,increase the cure rate.

关 键 词：腹部外伤 大出血 暂时性腹主动脉阻断 外科手术 

分 类 号：R656[医药卫生—外科学]