二期计划再手术治疗地震多发伤
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摘要
目的:探讨损伤控制策略(DC)治疗后地震多发伤病员的处理及APACHEⅡ评分判定计划再手术时机。方法:于2008年5月18日至6月30日对21例已实施DC的危重地震伤病员进行内科支持、外科干预,于重症监护室(ICU)恢复生理潜能,连续APACHEⅡ评分,判定伤病员生理状况及创伤程度,分期分阶段对骨与软组织伤实施关节内骨折的切开复位内固定、更改外固定支架为坚强的内固定方式、椎体爆裂骨折的内固定手术以及软组织重建等确定性手术。结果:通过二期计划再手术策略对伤病员的确定性治疗,21例患者得到有效救治,并发症少,伤残率低,无死亡事件。结论:适时评估患者生理潜能、判定手术时机、正确的选择手术方式可减少此类伤病员的并发症、伤残率及病死率。
Objective:To explore the treatment of casualties who suffered from multiple injuries in earthquake and had been treated by damage control(DC) immediately,and the definite postponed surgery time by way of APACHE Ⅱ score,Methods:From May to June 2008,21 casualties who had undergone DC accepted further treatment of medicine and surgery,and recovered physical potentiality in the intensive care unit(ICU).APACHE Ⅱ score was adopted to evaluate the casualties’ physical potentiality.Then,internal fixation of intra articular fractures and centrum fractures,alternation from external fixation to internal fixation,reconstruction of soft tissue was applied by stages according to the plan.Results:All the patients were effectively cured after definite postponed surgery.There was less complication,low deformity ratio and no death happened.Conclusion:Timely evaluation of the casualties' physical potentiality,appropriate surgery time and exact surgery can reduce the casualties' complication,deformity rate and death rate.
Objective:To explore the treatment of casualties who suffered from multiple injuries in earthquake and had been treated by damage control(DC) immediately,and the definite postponed surgery time by way of APACHE Ⅱ score,Methods:From May to June 2008,21 casualties who had undergone DC accepted further treatment of medicine and surgery,and recovered physical potentiality in the intensive care unit(ICU).APACHE Ⅱ score was adopted to evaluate the casualties’ physical potentiality.Then,internal fixation of intra articular fractures and centrum fractures,alternation from external fixation to internal fixation,reconstruction of soft tissue was applied by stages according to the plan.Results:All the patients were effectively cured after definite postponed surgery.There was less complication,low deformity ratio and no death happened.Conclusion:Timely evaluation of the casualties' physical potentiality,appropriate surgery time and exact surgery can reduce the casualties' complication,deformity rate and death rate.
引文
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[4]Rixen D,Grass G,Sauerland S,et al.Evaluation of criteria for tem-porary external fixation in risk adapted damage control orthopedic surgery of femur shaft fractures in multiple trauma patients:‘evi-dence based medicine’versus‘reality’in the trauma registry of the German Trauma Society.J Trauma,2005,59(6):13751394.
[5]Cunnion KM,Weber DJ,Broadhead WE,et al.Risk factors for nosocomial pneumonia:comparing adult critical care populations.Am J Respir Crit Care Med,1996,153(1):158162.
[6]Ho KM,Lee KY,Williams T,et al.Comparison of acute physiology and chronic health evaluation(APACHE)Ⅱscore with organ fail-ure scores to predict hospital mortality.Anaesthesia,2007,62(5):466473.
[7]朱立军,顾立强,裴国献.伤害控制骨科学-多发伤治疗最新观点.中华骨科杂志,2004,4(6):439442.
[2]Friedl HP,Trentz O.Multiple trauma:definition,shock,multiple organ failure.Unfallchirurgie,1992,18(2):6468.
[3]Holcomb JB,Jenkins D,Rhee P,et al.Damage control resuscitation:directly addressing the early coagulopathy of trauma.J Trauma,2007,62:307310.
[4]Rixen D,Grass G,Sauerland S,et al.Evaluation of criteria for tem-porary external fixation in risk adapted damage control orthopedic surgery of femur shaft fractures in multiple trauma patients:‘evi-dence based medicine’versus‘reality’in the trauma registry of the German Trauma Society.J Trauma,2005,59(6):13751394.
[5]Cunnion KM,Weber DJ,Broadhead WE,et al.Risk factors for nosocomial pneumonia:comparing adult critical care populations.Am J Respir Crit Care Med,1996,153(1):158162.
[6]Ho KM,Lee KY,Williams T,et al.Comparison of acute physiology and chronic health evaluation(APACHE)Ⅱscore with organ fail-ure scores to predict hospital mortality.Anaesthesia,2007,62(5):466473.
[7]朱立军,顾立强,裴国献.伤害控制骨科学-多发伤治疗最新观点.中华骨科杂志,2004,4(6):439442.
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