腹部创伤335例临床分析

目的:探讨提高腹部创伤、尤其是严重腹部多脏器损伤并发伤的早期诊断与抢救成功率.方法:总结我院1990年8月以来收治的335例腹部创伤的诊断、急救及诊疗经验.其中,男289例(86.3 %),女46例(13.7%),共损伤腹部脏器425个.闭合性腹部损伤277例(82.7%),开放性损伤58例( 17.3%),合并其它部位损伤249例次.结果:保守治疗65例(19.4% ),手术治疗270例(80.6%),死亡9例(2.7%),治愈326例(97.3%).结论:①腹腔穿刺、腹腔灌注、B 超、X线检查对闭合性腹部损伤有较高的诊断价值,准确率高,简便易行;②在心肺复苏,积极抗休克及处理多发伤的同时,应积极腹部探查,并应反复多点腹穿,动态观察腹部体征变化以减少腹部损伤的漏诊,提高诊断率;③正确掌握剖腹探查指征,认真全面地腹腔探查,合理使用有效抗生素,积极预防多功能器官障碍(MODS)或/和多器官功能衰竭(MOF)是抢救成功的关键.

Clinical Analysis of 335 Cases of Abdominal Trauma

Objective:To investigate and improve early dia gnosis and emergency treatment survival rate of abdominal injuries, especially severe abdominal multiple organ injur ies accompanied by multiple injuries. Methods:To summarize the experience in the diagnosis a nd emergency treatment of 335 abdominal trauma patients who were treated in our unit from Aug. 1990 to Aug. 19 99.Of the 335 cases, 289 patients were male (86.3%), and 46 were female ( 13.7% ) with a total of 425 abdominal organs injured. Of all these, 277 were cases with closed wounds (86.3%), 58 were cases with open wounds (17.3%), and 249 were case s accompanied with other body injuries. Results:65 patient s (19.4%) were given c onservative treatment, 270 (80.6%) were given operative treatment, 9(2.7 %) died, and 326 (97.3%) were cured. Conclusion:(1)Abdominocentesis , peritoneal lavage, ul trasonic B and X ray examinations played an important role in the diagnosis of closed abdominal injuries with high accuracy and simplicity. (2)Besides cardio p ulmonary resuscitation, antishock treatment measures and positive treatment of multiple injuries, laparotomy repeated multi point abdominocentesis and close observation of changes in abdominal signs should not be neglected so as to decre a se the rate of missed diagnosis. (3)The key to the success of emergency treatm e nt was to have g good grip of signs of exploratory laparotomy, to conduct thorou gh abdominal exploration, administers antibiotics and to take preventive measure s against multi organ dysfunction syndromes (MODS) and or multi organ failure (M OF).