腹部闭合性损伤急诊抢救体会(附255例报告)

目的探讨闭合性腹部损伤的临床特点,提高急诊抢救的整体水平.方法回顾性分析255例闭合性腹部损伤患者的临床资料.结果自外伤至就诊时间为15min～2天,腹腔内单一脏器伤118例,两个或以上脏器损伤137例,65例合并腹部以外的重要器官损伤;204例有不同程度的低血容量休克表现和/或腹膜炎表现,其中136例以低血容量休克表现为主,68例以腹膜炎表现为主;腹腔多点穿刺检查阳性率占74.5%(190/255).241例行急诊手术,急诊抢救治愈226例,抢救成功率93.8%;14例非手术治疗者,9例经保守治疗恢复,5例死亡.结论早期正确的诊断和及时合理的处理,是降低腹部创伤死亡的关键;维持生命体征,快速评估伤情,及时急诊手术是提高闭合性腹部损伤抢救成功率的原则;全面探查和通畅引流是剖腹的主要环节.

The Emergency Experience of Blunt Abdominal Trauma(255 cases)

Objective To investigate the clinical character of blunt abdominal trauma and improve the ability of emergency treatment. Methods There were 255 cases of blunt abdominal trauma whose clinical data were analysed retrospectively. Results The duration from trauma to hospitalizing was from 15 minutes to 2 days. There were 118 cases who got a single lesion of organ in abdomen, 137 got two or more lesions, and 65 cases had trauma besides in abdomen. Hypovolemic shock or/and acute peritonitis happened with 204 cases, among which 136 cases showed hypovolemic shock and 68 cases showed acute peritonitis. The positive rata of abdominal puncture was 74.5%(190/255). There were 241 cases who had emergency operation among which the recover rate was 93.8%(226/241);and 14 cases were given conservative treatment among which 9 cases recovered and 5 cases died. Conclusions The key factor to decrease the mortality of blunt abdominal trauma is to correctly diagnose and rational treat as early as possible. The first principles to improve the rescuing rate are maintaining vital sign, appraising the trauma condition and operating in time. The important step during operation is exploring completely and drainage smoothly.