基于损伤控制理论的救治管理对肝脏与胆管外伤患者救治效果的影响  

Effect of Treatment Management Based on Damage Control Theory on the Treatment Effect of Patients with Liver and Bile Duct Trauma

作　　者：刘燕 郭志丽 尚培中[3] 李晓武[3] 王金[3] LIU Yan;GUO Zhili;SHANG Peizhong;LI Xiaowu;WANG Jin(Department of Critical Care Medicine,the First Hospital of Zhangjiakou City,Zhangjiakou,Hebei 075000,China;Department of Emergency,the Second Hospital of Zhangjiakou City,Zhangjiakou,Hebei 075000,China;Department of General Surgery,the 81st Group Military Hospital of the People's Liberation Army of China,Zhangjiakou,Hebei 075000,China)

机构地区：[1]张家口市第一医院重症医学科,河北张家口075000 [2]张家口市第二医院急诊科,河北张家口075000 [3]中国人民解放军陆军第八十一集团军医院普外科,河北张家口075000

出　　处：《临床误诊误治》2024年第3期89-93,共5页Clinical Misdiagnosis & Mistherapy

基　　金：张家口市科学技术局科技计划项目(2021048D);河北省卫生健康委员会医学科学研究计划项目(20211129)。

摘　　要：目的 探究基于损伤控制理论的救治管理在肝脏与胆管外伤患者救治中的应用效果。方法 回顾性分析2022年8月—2023年3月收治的肝脏与胆管外伤102例的临床资料,根据临床处理方案分为观察组52例和对照组50例,对照组实施常规急诊救治,观察组实施基于损伤控制理论的救治管理。观察2组救治相关指标、并发症及干预前后损伤严重程度、氧化应激指标[髓过氧化物酶(MPO)、丙二醛(MDA)、超氧化物歧化酶(SOD)]变化情况。结果 观察组手术时间、术后肛门首次排气时间及住院时间均短于对照组,术中出血量少于对照组(P<0.01);干预后,观察组损伤严重程度轻于对照组(P<0.05);干预后,观察组血清MPO、MDA水平低于对照组,血清SOD水平高于对照组(P<0.05);观察组多器官功能障碍综合征、失血性休克发生率分别为3.85%(3/52)、1.92%(1/52),低于对照组的18.00%(9/50)、16.00%(8/50),差异有统计学意义(P<0.05)。结论 基于损伤控制理论的救治管理可降低肝脏与胆管外伤患者应激及损伤程度,加速康复进程,改善临床结局。Objective To explore the application effect of treatment management based on damage control theory(DCT) in the treatment of patients with liver and bile duct trauma.Methods The clinical data of 102 patients with liver and bile duct trauma treated from August 2022 to March 2023 were retrospectively analyzed.According to the clinical treatment plan,they were divided into the observation group(n=52) and the control group(n=50).The control group was treated with conventional emergency treatment,and the observation group was treated with treatment management based on DCT.The treatment-related indexes,complications and clinical outcomes,injury severity and oxidative stress indexes [myeloperoxidase(MPO),malondialdehyde(MDA),superoxide dismutase(SOD)] before and after intervention were observed in the two groups.Results The duration of operation,the first postoperative anal exhaust and length of hospital stay in the observation group were shorter than those in the control group,and the intraoperative blood loss was less than that in the control group(P<0.01).After intervention,the injury severity of observation group was lower than that of control group(P<0.05).After intervention,the serum MPO and MDA levels in the observation group were lower than those in the control group,while the serum SOD levels were higher than those in the control group(P<0.05).The incidence of multi-organ dysfunction syndrome and hemorrhagic shock in the observation group were 3.85%(3/52) and 1.92%(1/52),respectively,which were lower than those in the control group [18.00%(9/50) and 16.00%(8/50)],suggesting significant difference(P<0.05).Conclusion The treatment management based on DCT can reduce the stress and injury degree of patients with liver and bile duct trauma,accelerate the rehabilitation process,and improve the clinical outcome.

关 键 词：损伤控制 肝脏与胆管外伤 髓过氧化物酶 丙二醛 超氧化物歧化酶 多器官功能衰竭 休克 出血性 救治管理 

分 类 号：R641[医药卫生—外科学]