损害控制性手术在交通事故致严重肝破裂伤患者抢救中的应用  

Application of injury control surgery in the rescue of patients with severe liver rupture caused by traffic accident

作　　者：王雄飞 刘春庆[1] 高再生[1] 刘志苏[2] Wang Xiongfei;liu Chunqing;Gao Zaisheng;Liu Zhisu(Department of General Surgery,Beijing Daxing District People's Hospital,Beijing 102600,China;Department of General Surger-y,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]北京市大兴区人民医院普外科,北京102600 [2]武汉大学中南医院普外科,武汉430071

出　　处：《创伤外科杂志》2022年第6期464-467,共4页Journal of Traumatic Surgery

摘　　要：目的 探讨损害控制性手术(DCS)在交通事故致严重肝破裂伤患者抢救中的应用效果。方法 回顾性分析2009年3月—2020年3月北京市大兴区人民医院和武汉大学中南医院收治交通事故致严重肝破裂伤患者88例。男性49例,女性39例;年龄18~74岁,平均46.6岁;受伤至入院时间35~120min,平均65.1min,损伤严重度评分(ISS)(33.3±4.0)分,美国外科创伤学分(AAST)Ⅲ级22例、Ⅳ级25例、Ⅴ级41例。根据抢救过程中手术方法不同分为DCS组(52例)和对照组(36例),DCS组行DCS,对照组行一期确定性手术。比较两组患者抢救成功率、总手术时间、术后住院时间、术中出血量、术中输血量、并发症发生率等。结果 DCS组抢救成功率比对照组更高(92%vs.75%,P<0.05)。DCS组术后住院时间(12.4±3.8)d短于对照组(20.7±5.8)d,P<0.05。DCS组术中出血量(765.5±55.8)mL,术中输血量(558.8±124.5)mL均少于对照组(1096.5±98.5)mL、(2353.2±655.5)mL,P<0.05。DCS组确定性手术后24h的血清肿瘤坏死因子-α(TNF-α)(16.5±5.3)mmol/L,C反应蛋白(CRP)(39.2±10.2)mmol/L水平均低于对照组(25.6±7.5)mmol/L、(75.5±21.6)mmol/L,P<0.05。DCS组术后并发症总发生率(3.8%)显著低于对照组(19.4%)(P<0.05)。结论 交通事故致严重肝破裂伤行DCS能够有效减少术中出血,缩短确定性手术时间,减少术后并发症的发生,减轻炎症反应,提高患者近期生存率。Objective To explore the application effect of damage control surgery in rescuing patients with severe liver rupture caused by traffic accident.Methods The clinical data of 88 patients with severe liver rupture caused by traffic accident in Beijing Daxing District People’s Hospital and Zhongnan Hospital of Wuhan University were retrospectively analyzed.There were 49 males and 39 females,aged from 18 to 74 years,with an average of 46.6 years.The time from injury to admission was 35 to 120 minutes,with an average of 65.1 minutes.The injury severity score(ISS)was(33.3±4.0)points.There were 22 cases of AAST grade III,25 cases of AAST grade IV and 41 cases of AAST gradeⅤ.According to the different surgical methods in the rescue process,52 cases underwent injury control surgery(DCS group)and 36 cases underwent one-stage definitive surgery(control group).The rescue success rate,total operation time,postoperative hospital stay,intraoperative bleeding,intraoperative blood transfusion and the incidence of complications were compared between the two groups.Results The success rate of rescue in DCS group was higher than that in control group(92%vs.75%,P<0.05).The postoperative hospital stay in DCS group was(12.4±3.8)days,shorter than that in control group[(20.7±5.8)days,P<0.05].The intraoperative blood loss(765.5±55.8)mL and intraoperative blood transfusion(558.8±124.5)mL in DCS group were less than those in control group[(1096.5±98.5)mL,(2353.2±655.5)mL,P<0.05].In DCS group,serum TNF-αdetermined 24 hours after operation was(16.5±5.3)mmol/L and CRP(39.2±10.2)mmol/L were lower than those in the control group[(25.6±7.5)mmol/L and(75.5±21.6)mmol/L,P<0.05].The total incidence of postoperative complications in DCS group was 3.8%,which was significantly lower than that in control group(19.4%,P<0.05).Conclusion Damage control surgery can effectively reduce intraoperative bleeding,shorten definite operation time,reduce postoperative complications,reduce inflammatory reaction and improve the short-term survival rate o

关 键 词：肝破裂伤 损伤控制 道路交通伤 并发症 

分 类 号：R657.3[医药卫生—外科学]