严重大面积皮肤脱套伤伴多脏器损伤的急救处理

目的探讨严重大面积皮肤脱套伤伴多脏器损伤的手术急救处理和诊治方法。方法①根据患者具体情况，开放呼吸道，积极抗休克对症处理，低流量持续吸氧，密切监测生命体征。②即刻开放深静脉，根据中心静脉压（CVP）、平均动脉压（MAP）及时给予少量的晶体液和大量的胶体液以及相关的治疗药物。③留置导尿管，根据尿量进行指导性补液。④在实施手术急救的同时应用镇痛泵持续的静脉镇痛。结果经及时的诊断、抢救、治疗，患者病情稳定，脉搏氧饱和度（SpO2）≥95％，CVP（6．8±1．8）cm H2O（1cm H2O=0．098kPa），心率（HR）（84±12）次／min，MAP（80±10）mmHg（1mmHg=0．133kPa），白蛋白（27±9）g／L，血红蛋白（Hb）（116±22）g／L，血细胞比容（Hct）（48±4）％；肾脏泌尿功能恢复，尿量逐渐增加，尿色清亮，尿量（90±28）ml／h。12例患者中病情严重者手术结束后送入ICU进行进一步的支持治疗，其余的送入病房的重症监护室继续接受治疗。结论我们所采取的一系列紧急救治处理措施和方法是挽救严重大面积皮肤脱套伤伴多脏器损伤患者生命切实可行的治疗手段。

Emergency treatment of serious large area degloved skin injury complicated with multiple organ injury

Objective To investigate the emergency treatment of serious degloved skin injury complicated with multiple organ injury. Methods （1）According to the patients particular case, airway was opened, shock was treated early, low flow continuous renew its oxygen, closely examining the vital signs. （2）Deep vein was opened at once, according to the central vein pressure （CVP）, mean artery pressure （ MAP）, crystalloid solution and a lot of colloid solution and relevant drugs were given. （3）Leave the catheter, a quantity of water from a directional rehydration. （4）The disposable inqusion pump were used to ease the pain. Results All patients＇ condition were stable, oxygen saturation （SpO2） was more than 95%, CVP（6.8±1.8）cm H20, HR（84 ± 12）beats/rain, MAP（80 ± 10）mm Hg, Albumin（27±9）g/L, Hb （116 ± 22）g/L, Hot （48± 4）%. The urinary kidney function was in recovery, the urinary output was （90 ±28） ml/h. Patients who were seriously ill were sent into ICU treatment, the rest into the ward of the cared room only heal. Conclusions We had adopted a series of emergency treatment and the method is practicable to save serious large area degloved skin injury complicated with multiple organ injury.