目的 探讨损伤控制外科 (damage control surgery,DCS)在严重胸部创伤合并四肢骨折和骨盆骨折患者中的应用价值。方法 选取2014-08至2019-08武警江苏总队医院收治的严重胸部创伤合并四肢骨折和骨盆骨折的患者98例,按照实际接受的治疗方案分为对照组(n=46)和DCS治疗组(n=52)。对照组按传统治疗方案,早期行复杂、完整的确定性手术治疗,DCS治疗组按损伤DCS治疗策略10~14 d后完成确定性手术。手术后对两组的手术时间、手术出血量、术中输血量、总住院时间、入住ICU时间、机械通气时间及死亡率、并发症情况进行比较和分析。结果 对照组与DCS治疗组的总住院时间和入住ICU时间对比,差异无统计学意义;DCS治疗组手术时间(89.55±21.07 )min、使用呼吸机时间(5.62 d),均短于对照组的(178.83±28.50 )min、7.12 d,差异有统计学意义(P<0.05), DCS治疗组手术出血量(268.52±39.67)ml、术中输血量(610.85±40.24)ml明显少对照组(692.68±42.59)ml 、(1024.20±30.10) ml,差异有统计学意义(P<0.05);DCS治疗组并发症、死亡率明显低于对照组,差异有统计学意义(P<0.05)。结论 对严重胸部创伤合并四肢骨折和骨盆骨折患者采用DCS技术手术,可以提高患者的生存率,具有较好的临床实用价值。
Abstract
Objective To explore the applicability of damage control surgery for patients with severe chest trauma complicated with limb and pelvic fractures. Methods The clinical data on 98 patients with severe chest trauma complicated with limb fractures and pelvic fractures treated in our hospital between August 2014 and August 2019 was analyzed retrospectively. These patients were divided into the control group (46 cases) and the DCS treatment group (52 cases). Routine deterministic surgery was performed in the control group, while damage control surgery was performed in the DCS treatment group according to the injury control process within 10-14 days. After treatment, the duration of surgery, intraoperative bleeding volume, intraoperative blood transfusion volume, length of hospital stay, time spent in the ICU, days of mechanical ventilation, and rates of mortality and complications were compared between the two groups. Results The average length of hospital stay of the control group and the DCS treatment group was 26.91 d and 27.21 d respectively, compared with 13.12 d and 12.68 d in the ICU. There was no significant difference between the two groups. The duration of surgery of the two groups was (178.83±28.50 )min and (89.55±21.07 )min respectively, the days of mechanical ventilation were 7.12 d and 5.62 d respectively, the surgical bleeding volume was (692.68±42.59)ml and (268.52±39.67)ml respectively, and the intraoperative blood transfusion volume was(1024.20±30.10)ml and (610.85±40.24)ml respectively. There was statistically significant difference between the two groups (P<0.05).The complication rates of the control group and the DCS treatment group were 34.8% and 17.3% respectively, and the mortality rates were 23.9% and 7.7% respectively. There was significant difference between the two groups (P<0.05). Conclusions For patients with severe chest trauma combined with limb fractures and pelvic fractures, the use of damage control surgery can improve the survival rate of patients, which has good clinical value.
关键词
损伤控制 /
严重胸部创伤 /
盆骨骨折 /
四肢骨折
Key words
damage control surgery /
thoracic injury /
pelvic fracture /
limb fracture
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