损伤控制外科手术治疗外伤性肝脾破裂的效果观察  

Effect Observation of Damage Control Surgery on Treatment of Traumatic Liver and Spleen Rupture

作　　者：崔超 Cui Chao(Department of Emergency,Beijing Huairou Hospital,Beijing 101400,China)

机构地区：[1]北京怀柔医院急诊科,北京101400

出　　处：《中国社区医师》2022年第6期61-63,共3页Chinese Community Doctors

摘　　要：目的:分析损伤控制外科(DCS)手术对外伤性脾破裂的疗效。方法:选取2018年1月-2021年10月外伤性肝脾破裂患者共120例进行研究,依据随机数表法分为对照组(常规开展急诊手术)和观察组(采取DCS手术),各60例。比较两组患者手术指标,术前和术中肾素(R)、肾上腺素(E)、去甲肾上腺素(NE)和血管紧张素Ⅱ(ATⅡ)水平,术前和术后免疫球蛋白A(IgA)、免疫球蛋白G(IgG)和免疫球蛋白M(IgM)水平,观察术后近期病死率、并发症情况。结果:观察组术中失血量及治疗费用少于对照组,手术时间、术后卧床时间及总住院时间短于对照组,差异有统计学意义(P<0.05)。术前,两组R、E、NE以及ATⅡ水平相比差异无统计学意义(P>0.05);术中,两组R、E、NE以及ATⅡ水平均升高,但观察组R、E、NE以及ATⅡ水平低于对照组,差异有统计学意义(P<0.05)。术前,两组IgA、IgG、IgM水平相比差异无统计学意义(P>0.05);术后,两组IgA、IgG、IgM水平均升高,且观察组IgA、IgG、IgM水平高于对照组,差异有统计学意义(P<0.05)。观察组术后近期病死率、并发症发生率均低于对照组,差异有统计学意义(P<0.05)。结论:DCS手术对外伤性肝脾破裂疗效确切,能降低患者的手术创伤及病死率,缩短手术时间,促进术后恢复,减轻应激反应,增强免疫功能,减少并发症发生和治疗费用,值得推广。Objective:To analyze the effectiveness of damage control surgery(DCS)on treatment of traumatic liver and spleen rupture.Methods:One hundred and twenty patients with traumatic liver and spleen rupture from January 2018 to October 2021 were selected.According to random number table,patients were divided into control group(routine emergency operation)and observation group(DCS),with 60 cases in each group.Surgical indicators under different surgical approaches;renin(R),epinephrine(E),norepinephrine(NE)and angiotensin II(ATⅡ)levels before and after treatment;immunoglobulin A(IgA),IgG and IgM levels before and after treatment;short-term mortality after surgery;and complications were compared between two groups.Results:The intraoperative bleeding loss volume and treatment costs in the observation group were lower than those in the control group,the operation time,postoperative bedridden time and overall hospital stays in the observation group were shorter than those in the control group,and the difference was statistically significant(P<0.05).Before surgery,the differences of R,E,NE and ATⅡlevels between two groups were not significantly different(P>0.05);during surgery,R,E,NE and ATⅡlevels in two groups were increased,but R,E,NE and ATⅡlevels in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.05).Before surgery,the differences of IgA,IgG,IgM levels between two groups were not significantly different(P>0.05);during surgery,IgA,IgG,IgM levels in two groups were increased,but IgA,IgG,IgM levels in the observation group were higher than those in the control group,and the difference was statistically significant(P<0.05).The short-term mortality after surgery and complication rate in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.05).Conclusion:DCS is effective in treating traumatic liver and spleen rupture,it can reduce the surgical trauma and mortality,shorten operation time,p

关 键 词：外伤性肝脾破裂 损伤控制外科 外科手术 应激反应 免疫功能 

分 类 号：R657.62[医药卫生—外科学] R657.32[医药卫生—临床医学]