137例多发伤临床诊治分析

目的分析多发伤的临床特点,探讨早期预测多发伤严重度、预后的有关指标及综合治疗的意义。方法回顾性分析收入ICU的137例多发伤患者的致伤原因、治疗方法、早期血乳酸及离子钙水平、ISS评分,同时按ISS评分、预后及有无合并颅脑损伤分组。结果多发伤主要致伤原因为交通事故伤（82例,59.85%）、坠落伤（27例,19.7%）;主要受伤部位颅脑损伤（43例,31.4%）、腹部和骨盆损伤（38例,27.7%）、胸部损伤（22例,16.1%）;死亡组患者早期血乳酸水平、ISS评分显著高于存活组患者（P〈0.01）,死亡组患者早期离子钙水平显著低于存活组患者（P〈0.01）,合并颅脑损伤患者死亡率明显升高（P〈0.01）。结论多发伤致病因素复杂,早期血乳酸离子钙水平和ISS评分对评估创伤患者严重程度及预后有一定的意义,以损伤控制为主导的综合治疗特别是重视颅脑损伤的治疗是多发伤救治成功的关键。

Clinical Diagnosis and Treatment of 137 Patients with Multiple Injuries

Objective To analyze the clinical feature of multiple injuries,investigate the early prediction index and comprehensive treatment.Methods The cause of injury,treatment,blood lactate,ionized calcium and ISS scores of 137 patients with multiple injuries were analyzed retrospectively.All patients were divided into two groups based on ISS,prognosis and head injury.Results The major cause of injury were road traffic injury（82 cases,59.85%） and falling injury（27 cases,19.7%）;The main involved positions included head injury（43 cases,31.4%）;abdomen and pelvis injury（38 cases,27.7%） and chest injury（22 cases,16.1%）;The blood lactate and ISS in the death group were significantly higher than that in the survival group（P〈0.01）,and the ionized calcium in the death group was significantly lower than that in the survival group（P〈0.01）.The mortality rate increased when the head injury was accompanied（P〈0.01）.Conclusion The multiple injuries have various causes,the levels of serum lactic and ionized calcium can be used to predict the severity of injury and prognosis,led to damage control for the comprehensive treatment,in particular pay attention to the treatment of head injury is the key to successful treatment