严重肝脏损伤伴大失血的损害控制性复苏救治

目的：探讨损害控制性复苏在抢救严重肝脏损伤伴大失血患者的救治策略。方法回顾性分析2009年1月～2014年1月31例严重肝脏损伤伴大失血患者（男性20例，女性11例；年龄19～75岁，平均32.7岁）应用损害控制性复苏（限制性液体复苏、止血性复苏、损害控制手术）救治情况，统计其治疗结果，包括复苏结果、最终效果以及术后并发症。结果31例均出血控制后成功复苏；24例在术后送入ICU前即达到初期复苏目标[心率≤120次／min，血压90／60mmHg，中心静脉压6～8mmHg，尿量0.5～1ml／（kg· min），血红蛋白80～100g／L，红细胞压积0.3～0.35]，弥散性血管内凝血（DIC）发病3例（9.69％）；治愈26例，死亡5例（16.13％），主要死亡原因为合并伤及术后并发症。结论应用损害控制性复苏策略救治严重肝脏损伤伴大失血，及早纠正低体温、酸中毒、凝血障碍，可显著提高生存率。

Damage control resuscitation in the treatment of severe liver trauma with great blood loss

Objective To discuss the treatment strategies of damage control resuscitation in rescuing severe liver trauma with great blood loss.Methods Thirty-one cases(20 males and 11 females ranged from 19 to 75 years with and average of 32.7 years) of severe liver trauma with great blood loss treated with damage control resuscitation strategy ( limited fluid resuscitation , hemorrhagic resuscitation , damage control operation ) were retrospectively ana-lyzed from Jan.2009 to Jan.2014.The treatment outcome,including the resuscitative results,the outcome and the complications was analyzed .Results Resuscitation surgeries were successfully conducted in all patients .Twenty-four cases reached resuscitation goal [HR≤120 times/minutes,BP 90/60mmHg,CVP 6-8mmHg,urine volume 0.5-1ml/(kg· min)] before sent to the ICU.Three cases developed disseminated intravascular coagulation .Twenty six patients were cured and 5(16.13%) died.Conclusion Application of damage control resuscitation in the treatment of patients with severe liver injury with great blood loss ,combined with early correction of hypothermia ,aci-dosis,and coagulation disorders ,can significantly improve the survival rates .