损害控制性复苏策略在严重多发伤急救中的应用研究  

Application of damage control resuscitation strategy in emergency treatment of severe multiple injuries

作　　者：茅文斌 秦燕明 汤勇 王鹏 崔恒熙 MAO Wen-bin;QIN Yan-ming;TANG Yong;WANG Peng;CUI Heng-xi(Department of Emergency Surgery,Zhenjiang First People's Hospital(Affiliated People's Hospital of Jiangsu University),Zhenjiang,Jiangsu 212002,China)

机构地区：[1]镇江市第一人民医院(江苏大学附属人民医院)急诊外科,江苏镇江212002

出　　处：《创伤外科杂志》2020年第11期860-863,877,共5页Journal of Traumatic Surgery

摘　　要：目的探讨损害控制性复苏策略在严重多发伤急救中的应用效果。方法回顾性分析镇江市第一人民医院急诊外科2014年3月—2020年2月收治的150例严重多发伤患者的临床资料,男性90例,女性60例;年龄21~82岁,平均43.37岁。受伤至就诊时间平均(28.54±3.39)h,GCS评分平均(4.52±1.74)分;颅脑损伤43例,胸腹伤64例,脊柱、四肢及血管损伤43例。根据急救过程中所采用复苏方式的不同分为两组对照组(52例)进行积极液体复苏配合损害控制性手术,观察组(98例)采用损害控制性复苏策略(限制性液体复苏+损害控制性手术+止血性复苏)。回顾性分析两组患者的液体复苏情况,对比两组患者治疗前后的凝血功能、剩余碱、乳酸等水平变化及预后情况。结果所有患者随访3个月。观察组患者的胶体液输注量、晶体液输注量、浓缩红细胞输注量分别为0、(1887.9±285.4)mL、(1537.8±353.2)mL,均明显较对照组少;观察组血浆输注量为(1853.1±414.2)mL,明显较对照组多(P<0.05)。观察组入院48h的凝血酶原时间(PT)、活化部分凝血酶时间(APTT)均明显短于对照组(12.2±3.1)s vs.(14.6±3.8)s,(32.1±15.6)s vs.(42.6±15.6)s,P<0.05。与对照组相比,观察组入院48h的剩余碱(BE)水平明显更高(-2.13±0.31)mmol/L vs.(-5.84±0.59)mmol/L,乳酸(LA)水平明显更低(2.21±0.24)mmol/Lvs.(4.05±0.36)mmol/L,P<0.05。与对照组相比,观察组入院48h的剩余碱(BE)、乳酸(LA)水平均明显更低(8.13±2.20)mmol/L vs.(9.84±3.11)mmol/L,(2.21±0.24)mmol/L vs.(4.05±0.36)mmol/L,P<0.05。与对照组相比,观察组的体温恢复时间、乳酸清除时间、凝血功能恢复时间较对照组更短(4.85±1.24)h vs.(9.52±2.24)h,(11.56±4.23)h vs.(26.35±5.24)h,(13.44±1.15)h vs.(30.21±12.58)h,P<0.05。对照组的预后良好率为36.5%(19/52),观察组为64.3%(63/98),组间比较差异有统计学意义(P<0.05)。对照组的病死率为11.5%(6/52),观察组为5.1%(5/98),组间比较差异有统计Objective To discuss the application of damage control resuscitation strategy in emergency treatment of severe multiple injuries.Methods The clinical data of 150 patients with severe multiple injuries admitted to the Department of Emergency Surgery of Zhenjiang First People's Hospital from Mar.2014 to Feb.2020 were selected and analyzed retrospectively.There were 90 males and 60 females with an average age of 43.4 years;the average time from injury to treatment was(28.54±3.39)hours,and the average GCS score was(4.52±1.74)points;43 cases were craniocerebral injury,64 cases were thoracoabdominal injury,and 43 cases were spinal,limb and vascular injury.According to the different resuscitation methods used in the emergency process,they were divided into two groups:the control group(52 cases)received active fluid resuscitation combined with damage control surgery,and the observation group(98 cases)adopted damage control resuscitation strategy(limited fluid resuscitation+damage control surgery+hemostatic resuscitation).Retrospective analysis of the two groups of patients with fluid resuscitation was carried out,coagulation function,residual alkali,lactic acid and other changes and prognosis of two groups of patients before and after treatment were compared.Results All patients were followed up for 3 months.The infusion volume of colloidal solution,crystalloid solution and concentrated red blood cell in the observation group were 0,(1887.9±285.4)mL and(1537.8±353.2)mL,respectively,which were significantly less than those of the control group;the plasma infusion volume of the observation group was(1853.9±414.2)mL,significantly more than that of the control group(P<0.05).The prothrombin time(PT)and activated partial thromboplastin time(APTT)in the observation group were significantly less than those in the control group[(12.2±3.1)seconds vs.(14.6±3.8)seconds,(32.1±15.6)seconds vs.(42.6±15.5)seconds,P<0.05].Compared with the control group,the level of residual base(BE)in the observation group was significantly hig

关 键 词：多发伤 损害控制 液体复苏 止血 凝血功能障碍 

分 类 号：R641[医药卫生—外科学]