一线三甲医院汶川地震107例多发伤合并胸伤的救治分析
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摘要
目的总结汶川地震中多发伤合并胸伤的救治方法及效果。方法回顾性分析汶川地震后至2008年5月31日我院收治107例多发伤合并胸伤地震伤员的一般情况、救治情况及转归、死因等临床资料。结果多发伤急诊手术病死率前3位分别为肝修补、脾切除、颅内血肿清除减压;胸伤紧急处置病死率前3位分别为呼吸机支持、气管插管、胸腔闭式引流;多发伤分类病死率前3位分别为ARDS、胸骨骨折、连枷胸;死亡伤员均为AIS-90创伤严重度评分(ISS)评分很高的重度、极重度多发伤,颅脑伤、腹腔脏器伤和四肢骨盆伤是致死的主要因素之一,严重胸伤也是伤员致死的重要因素之一。结论汶川地震多发伤合并胸伤的救治中,严重创伤所导致的失血性休克和重型颅脑伤是伤员死亡的主要原因;胸伤的严重程度是死亡的重要因素之一。损伤部位越多、ISS评分越高、胸伤越重,病死率越高。迅速检查、快速诊断和分诊,尽早胸伤紧急处置,能为进一步抢救创造机会,提高抢救成功率。
Objective To summarize the treatment and outcomes of patients with multiple injuries combined with thoracic trauma following the Wenchuan earthquake. Methods The wounded patients admitted from 12th to 31st May with multiple injuries combined with thoracic trauma after the earthquake were retrospectively analyzed. This includes baseline information, treatments, outcomes and deaths. Results Liver repair, spleen abscission, decompression and removed of intracranial hematoma ranked the first three of the main reasons for the emergency surgery death of multiple injuries. Heart-lung machine support, trachea cannula and closed drainage of thoracic cavity ranked the first three of the main reasons for the death of thoracic trauma. Moreover, ARDS, fracture of sternum and flail chest ranked the first three of the main reasons for the death of other multiple injuries. All the casualties had the worst situation with high ISS scores. The main death reasons were cerebral wound, peritoneum viscera injuries and the four limbs and pelvis injuries. Besides, the severe thoracic trauma accelerated their death. Conclusion Main death reasons for the inpatients with multiple injuries combined with thoracic trauma are hemorrhagic shock and severe cerebral wound. The thoracic trauma degree will increase the risk of their death. The more the injury positions, the higher ISS scores, and the more serious thoracic trauma, the higher mortality rate. Rapid examination and diagnosis, rapied triage and distribution of thoracic trauma can help to create more chances for the further treatment and increase the success rate of rescue.
Objective To summarize the treatment and outcomes of patients with multiple injuries combined with thoracic trauma following the Wenchuan earthquake. Methods The wounded patients admitted from 12th to 31st May with multiple injuries combined with thoracic trauma after the earthquake were retrospectively analyzed. This includes baseline information, treatments, outcomes and deaths. Results Liver repair, spleen abscission, decompression and removed of intracranial hematoma ranked the first three of the main reasons for the emergency surgery death of multiple injuries. Heart-lung machine support, trachea cannula and closed drainage of thoracic cavity ranked the first three of the main reasons for the death of thoracic trauma. Moreover, ARDS, fracture of sternum and flail chest ranked the first three of the main reasons for the death of other multiple injuries. All the casualties had the worst situation with high ISS scores. The main death reasons were cerebral wound, peritoneum viscera injuries and the four limbs and pelvis injuries. Besides, the severe thoracic trauma accelerated their death. Conclusion Main death reasons for the inpatients with multiple injuries combined with thoracic trauma are hemorrhagic shock and severe cerebral wound. The thoracic trauma degree will increase the risk of their death. The more the injury positions, the higher ISS scores, and the more serious thoracic trauma, the higher mortality rate. Rapid examination and diagnosis, rapied triage and distribution of thoracic trauma can help to create more chances for the further treatment and increase the success rate of rescue.
引文
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10杨帆,白祥军,唐朝晖,等.4519例多发伤院内救治分析.中国医学科学院学报,2007,29(4):471-477.
11Buduhan G,McR itchie DI.Missed injuries in patients with multiple trauma.J Trauma,2000,49(3):600-605.
2Ozdogˇan S,Hocaogˇlu A,Cagˇlayan B,et al.Thorax and lung injuries arising from the two earthquakes in Turkey in1999.Chest,2001,120(4):1163-1166.
3张连阳.胸部创伤救治现状.创伤外科杂志,2007,9(5):475-477.
4Ghodsi SM,Zargar M,Khaji A,et al.Chest injury in victims of Bam earthquake.Chin J Traumatol,2006,9(6):345-348.
5王一镗.严重创伤救治的策略—损伤控制性手术.中华创伤杂志,2005,21(1):32-35.
6Hoey BA,Schwab CW.Damage control surgery.Scand J Surg,2002,91(1):92-103.
7赵喜森.重症难治性休克的机制和治疗.中华创伤杂志,2003,19(16):325.
8Varela JE,Cohn SM,Diaz I,et al.Splanchnic perfusion during delayed,hypotensive,or aggressive fluid resuscitation from uncontrolled hemorrhage.Shock,2003,20(5):476-480.
9李泽坚.我国胸外科的发展和展望.中华外科杂志,2006,14(2):937-939.
10杨帆,白祥军,唐朝晖,等.4519例多发伤院内救治分析.中国医学科学院学报,2007,29(4):471-477.
11Buduhan G,McR itchie DI.Missed injuries in patients with multiple trauma.J Trauma,2000,49(3):600-605.
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