“三明治”法负压纱布填塞治疗严重腹部外伤合并出血的应用效果  

Clinical outcomes of sandwich negative pressure gauze packing in treatment of severe abdominal trauma with hemorrhage

作　　者：储诚南 丁威威 杨超 王新宇 陈方 王凯 李维勤 黎介寿 Chu Chengnan;Ding Weiwei;Yang Chao;Wang Xinyu;Chen Fang;Wang Kai;Li Weiqin;Li Jieshou(Department of Critical Care Medicine,Jinling Hospital,Medical School of Nanjing University(General Hospital of Eastern Theater Command),Nanjing 210002,China;Research Institute of General Surgery,Jinling Hospital,Medical School of Nanjing University(General Hospital of Eastern Theater Command),Nanjing 210002,China)

机构地区：[1]南京大学医学院附属金陵医院(东部战区总医院)重症医学科,南京210002 [2]南京大学医学院附属金陵医院(东部战区总医院)普通外科研究所,南京210002

出　　处：《中华危重症医学杂志（电子版）》2021年第6期453-459,共7页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：国家自然科学基金项目(81770532);江苏省青年医学重点人才项目(QNRC2016901)。

摘　　要：目的探讨“三明治”法负压纱布填塞治疗严重腹部外伤合并出血的应用效果。方法采用回顾性病例对照研究分析2016年1月至2020年9月东部战区总医院重症医学科战创伤救治中心收治的40例因严重腹部外伤合并出血经药物、介入及外科止血无效使用纱布填塞治疗患者的临床资料。根据纱布填塞方式分为传统纱布填塞组(传统组,19例)和“三明治”法负压纱布填塞组(“三明治”组,21例)。比较两组患者的一般资料、创伤严重程度评分(ISS)、序贯器官衰竭估计(SOFA)评分、术中情况及ICU复苏资料、生命体征及实验室检查、并发症情况、预后及随访等资料。结果两组患者经手术纱布填塞止血、ICU复苏支持后,生命体征得到改善。“三明治”组ISS评分[(26±4)分vs.(19±6)分]、SOFA评分[(16±3)分vs.(13±4)分]及纱布填塞时间[(5.0±1.2)d vs.(3.0±0.7)d]均明显高于传统组(t=4.494、2.713、6.404,P均<0.05)。两组患者损伤控制性手术时、手术后第3天以及确定性手术时体温、心率、pH值、血红蛋白、白细胞计数、降钙素原、C反应蛋白、D-二聚体、凝血酶原时间及活化部分凝血酶原时间水平比较,差异均有统计学意义(F=27.590、25.533、39.777、17.483、4.486、44.236、5.628、38.616、8.689、13.212,P均<0.05)。“三明治”组患者术后感染情况(3/21 vs.8/19)及总体并发症(5/21 vs.13/19)均较传统组显著降低(χ^(2)=3.872、8.021,P=0.049、0.005);但两组患者死亡情况比较,差异无统计学意义(1/21 vs.3/19,χ^(2)=1.348,P=0.331)。出院患者随访(6±3)个月,均存活。结论对于严重腹部外伤合并出血的患者,采用纱布填塞治疗可改善患者生命体征。与传统纱布填塞相比,“三明治”法负压纱布填塞能显著延长填塞时间,减轻全身感染情况,降低并发症发生率。Objective To explore the effect of"sandwich"method of negative pressure gauze packing in the treatment of severe abdominal trauma with bleeding.Methods A retrospective case-control study was used to analyze the clinical data of 40 patients with severe abdominal trauma combined with bleeding who were treated with gauze packing due to ineffective hemostasis by drugs,intervention and surgery in the Division of Trauma and Surgical Intensive Care Unit,General Hospital of Eastern Theater Command from January 2016 to September 2020.According to the gauze packing method,they were divided into a traditional gauze packing group(traditional group,19 cases)and a"sandwich"negative pressure gauze packing group("sandwich"group,21 cases).The general data,injury severity score(ISS),sequential organ failure assessment(SOFA)score,intraoperative conditions and ICU resuscitation data,vital signs and laboratory tests,complications,prognosis and follow-up data were compared between the two groups.Results The vital signs of the two groups were improved after surgical gauze packing for hemostasis and ICU resuscitation support.In the"sandwich"group,the ISS scores[(26±4)vs.(19±6)],SOFA scores[(16±3)vs.(13±4)]and gauze packing time[(5.0±1.2)d vs.(3.0±0.7)d]were significantly higher than those in the traditional group(t=4.494,2.713,6.404;all P<0.05).The body temperature,heart rate,p H,hemoglobin,white blood cell count,procalcitonin,C-reactive protein,D-dimer,prothrombin time and activated partial prothrombin time levels during damage control surgery,on the 3 rd day after surgery and during definitive surgery were statistically significantly different between the two groups(F=27.590,25.533,39.777,17.483,4.486,44.236,5.628,38.616,8.689,13.212;all P<0.05).The postoperative infection(3/21 vs.8/19)and overall complications(5/21 vs.13/19)in the"sandwich"group were significantly lower than those in the traditional group(χ^(2)=3.872,8.021;P=0.049,0.005);however,there was no significant difference in death between the two groups(1/21 vs.3/19,�

关 键 词：创伤和损伤 出血 止血技术 纱布填塞 

分 类 号：R656[医药卫生—外科学]