严重腹部创伤伴颅脑损伤患者急诊一体化外科手术策略及预后分析  

Emergency integrated surgical strategy and prognosis of patients with severe abdominal trauma with craniocerebral injury

作　　者：闫金亮[1] 田景中[1] 傅家清 柴大林 Yan Jinliang;Tian Jingzhong;Fu Jiaqing;Chai Dalin(Department of Emergency Surgery,Bozhou People’s Hospital,Bozhou,Anhui 236800,China)

机构地区：[1]亳州市人民医院急诊外科,安徽亳州236800

出　　处：《创伤外科杂志》2021年第9期663-667,共5页Journal of Traumatic Surgery

摘　　要：目的分析急诊一体化外科救治策略在严重腹部创伤伴颅脑损伤患者急救中的应用效果。方法回顾性分析2016年1月—2019年6月亳州市人民医院急诊外科收治的112例严重腹部创伤伴颅脑损伤患者临床资料,其中男性60例,女性52例;年龄20~53岁,平均48.5岁;脑挫裂伤12例,脑干挫伤12例,硬膜下及硬膜外血肿2例,单纯硬膜外血肿36例,腹部伤经剖腹后确诊:肝破裂5例,脾破裂6例,胃肠破裂12例,其中有7例为实质、空腔脏器均有破裂伤,网膜、系膜血管破裂伤6例;其他合并伤有血气胸3例,肾挫裂伤2例,四肢骨折5例,骨盆骨折、后腹膜血肿4例。将接受常规化急诊外科手术策略的56例患者纳入常规化外科组,实施气道控制、循环监测等措施,及时进行创伤止血包扎固定;将接受急诊一体化外科救治策略的56例患者纳入一体化外科组,行修复创伤一期手术治疗,术后送ICU监护观察,并继续抗休克、抗感染等治疗。对比两组的基线资料、术中出血量、术中红细胞输注总量、术后体温恢复时间、术后抗凝血酶(AT)、血浆凝血酶原(PT)恢复时间和术后乳酸恢复时间、术后美国国立卫生研究院卒中量表(NIHSS)、预后及并发症发生率的差异。结果两组性别分布、平均年龄、致伤原因、脑伤类型、脑伤表现、腹伤类型、腹伤表现等基线资料比较,差异无统计学意义(P>0.05)。一体化外科组的急诊室滞留时间(10.73±2.14)min、多学科会诊等待时间(7.53±1.95)min、辅助检查等待时间(12.62±3.19)min、急诊转至手术室时间(10.83±2.62)min均短于常规化外科组[(15.91±3.05)min、(10.48±2.32)min、(19.65±4.30)min、(16.77±3.48)min,P<0.05],一体化外科组的良好恢复率高于常规化外科组(64.29%vs.23.21%,P<0.05),而一体化外科组的轻度伤残率、重度伤残率、植物生存(或病死)率均低于常规化外科组(28.57%vs.48.21%,5.36%vs.17.86%,1.79%vs.10.71%,P<0.05)。结论给�Objective To analyze the application effect of the integrated emergency surgical strategy in the first aid of patients with severe abdominal trauma and craniocerebral injury.Methods A retrospective analysis was conducted in the clinical data of 112 patients with severe abdominal trauma and craniocerebral injury admitted to the Department of Emergency Surgery of Bozhou People’s Hospital from Jan.2016 to Jun.2019.There were 60 males and 52 females,aged 20-53 years,with an average age 48.5 years;there were 12 cases of brain contusion and laceration,12 cases of brainstem contusion,2 cases of subdural and epidural hematoma,and 36 cases of simple epidural hematoma.The abdominal injury was confirmed by laparotomy:5 cases of liver rupture,6 cases of spleen rupture,12 cases of gastrointestinal rupture,of which 7 cases were parenchymal,cavities and organs were ruptured,and omentum and mesangial vessels were ruptured in 6 cases;other combined injuries included blood pneumothorax in 3 cases,kidney contusion in 2 cases,limb fractures in 5 cases,and pelvic fractures and retroperitoneal hematoma in 4 cases.The 56 patients who received routine emergency surgery strategies were put into the routine surgery group,which performed measures such as airway control,circulatory monitoring,and timely traumatic hemostasis bandaging and fixation;the 56 patients who received emergency integrated surgical strategies were put into integrated surgery group,which performed trauma repair,and patients were sent to ICU for anti-shock and anti-infection treatments.The baseline data,intraoperative blood loss,intraoperative total red blood cell transfusion,postoperative body temperature recovery time,postoperative antithrombin(AT),plasma prothrombin(PT)recovery time,postoperative lactate recovery,postoperative National Institutes of Health Stroke Scale(NIHSS),prognosis and complication rate were compared between the two groups.Results There was no statistically significant difference between the two groups in terms of gender distribution,average ag

关 键 词：腹部创伤 颅脑损伤 急诊一体化外科救治 预后 

分 类 号：R656[医药卫生—外科学]