42例严重腹部损伤救治体会

严重腹部损伤往往为多发伤、合并伤,如果有腹腔实质脏器或大血管损伤,可因大出血而导致死亡。空腔脏器受损伤破裂时,可因发生严重的腹腔感染而威胁生命。因此,早期正确的诊断和及时合理的救治,是降低腹部创伤死亡的关键。笔者自1990年9月到2002年10月,急诊救治严重腹部损伤42例,现将诊断和救治情况报道如下。1临床资料1.1一般资料:本组42例,男30例,女12例;年龄10～73岁,平均24岁。1.2致伤原因:交通事故伤17例,打架斗殴伤11例,坠落伤5例,刀刺伤3例,压砸伤5例,高速枪弹伤1例。损伤后来院时间0.5～4小时,平均1.2小时。1.3闭合性腹部损伤33例(占…     

汶川地震腹部损伤的救治体会与思考

At 2:28 p.m. local time on 12 May, 2008, the Wenchuan earthquake struck with a magnitude of 8.0. After the earthquake, 1364 injured persons, including 732 women and 632 men, were admitted to Deyang People's Hospital. The ages of the injured persons ranged from 0.2 years to 102 years (mean, 42.5 years). Of all injured persons, 4.65% aged under 7 years, 13.84% between 7 and 18 years, 39.57% between 19 and 45 years, 24.48% between 46 and 65 years, and 17.46% above 65 years. A total of 1713 injuries were found in all the injured persons, and the predominant injuries were found in limbs, body surface, head and chest. The incidence of the multiple injuries was 23.64%. Eighteen persons with abdominal injuries received operation. Prompt, accurate and systematic evaluation of the injury is necessary in raising the rescue efficiency. Treating the injured persons according to a classification optimizes the usage of the limited medical resources. Early definitive operation is crucial in rescuing the lives of the injured persons, and the treatment should be applied within 24 hours after the earthquake, then the emphasis of the rescue work should shift to helping orthopedic surgeons with operation and debridement.     

以腹部损伤为主的严重多发伤150例救治体会

目的：总结严重腹部多发伤的诊治经验,进一步提高救治水平。方法：回顾性分析2002年1月～2012年2月收治的150例严重腹部多发伤患者的临床资料。结果：对25例伴有严重腹部损伤,创伤严重度（ISS）评分30分的多发伤患者,实施了分阶段的创伤控制救治,成功18例。重症监护病房（ICU）平均住院24．3天。临床治愈105例（70％）,残疾30例（20％）,死亡15例（10％）。再手术17例,漏诊5例,胰瘘2例,应激性溃疡大出血10例,急性肾衰10例,多器官功能障碍综合征（MODS）10例,败血症3例,二重感染2例,假膜性肠炎伴消化出血1例。结论：结合病史、体检、腹腔穿刺、腹部彩超、CT、X线检查等可提高诊断率,并为腹部外伤治疗提供可靠依据。尽早行确定性手术治疗、快速有效止血、术中探查避免遗漏脏器损伤、正确处理合并伤是减少并发症、降低病死率的主要措施。     

浅谈汶川地震腹部损伤

The character, classification, scoring, diagnosis and treatment of abdominal injuries after the Wenchuan earthquake were analyzed based on the data collected in Chengdu and Dujiangyan. Most of the abdominal injuries were closed injury, and complicated with injuries in other organs. All the injured persons were classified into different groups according to the degree of injuries, so as to determine the optimal sequence of treatment. Open abdominal injuries were comparatively easy to diagnose, while the diagnosis of closed abdominal injuries was difficult and consisted of preoperative diagnosis and intraoperatire exploration. The principle of damage control surgery should be well followed in rescuing the persons with severe abdominal injuries.     

汶川地震德阳市腹部损伤的调查与分析

A magnitude of 8.0 earthquake struck on Wenchuan on May 12, 2008. Until July 1, 1393 injured persons had been admitted to Deyang People's Hospital. Of all injured persons, 32 were diagnosed with abdominal injury, including 18 men and 14 women. All the abdominal injuries were closed injury, and multiple abdominal viscera were involved in the abdominal injuries after the earthquake. Careful examination is crucial in preventing missed diagnosis. The incidences of the liver and spleen injuries were significantly higher than that of the intestine, and the reason may be that the liver and spleen are the parenchymal viscera. Diagnostic abdominocentesis can timely diagnose the parenchymal viscera with severe blood loss. Diagnostic peritoneal lavage combined with selective CT scan can timely diagnose the abdominal injuries with comparatively low cost.     

严重腹部损伤并多发伤的救治

多发伤为同一致伤因素所造成的两个或以上的组织器官、部位的严重损伤，常伴有创伤失血性休克等一系列严重生理功能紊乱，危及生命。随着社会的发展，交通事故、工伤、火器锐器伤等意外伤害所造成的严重多发伤逐渐增多。其中，严重腹部损伤并多发伤占很大的比例，又因其常伤及头、胸、腹部等重要脏器，病情危重复杂，易误诊漏诊，死亡率高。本文主要对其救治程序、诊治原则及术后处理作一讨论。     

肝破裂50例救治体会

腹部创伤中,肝破裂较为常见,据统计,开放性腹部损伤中发生率约占30%,闭合性腹部损伤中约占20%[1]。我院1995~2005年共收治肝破裂病人50例,报告如下:1临床资料1.1一般资料:本组50例,男43例,女7例,年龄10~66岁,病程40min~6h,平均为2.5h。致伤原因、部位及程度:车祸伤21例,砸伤15例,坠落伤14例;单纯肝右叶损伤41例(其中脏面12例,膈面17例,脏面隔面均伤12例),肝左右叶损伤9例;合并其他脏器损伤13例。肝脏损伤程度分级参照美国创伤外科协会(AAST)制定的肝外伤分级标准:Ⅰ级:肝实质裂伤深度<1cm(9例);Ⅱ级:肝实质裂伤深度1~3cm(21例);Ⅲ级:肝实…     

腹部损伤的诊治

一、腹部损伤的概况腹部损伤包括机械性(创伤)、化学性和放射性损伤,创伤为主体,在战时和平时均十分常见。其发生率在平时约占各种损伤的0.4%~1.8%;在战时约占5%~8%,在对越自卫反击战中为4%。腹部创伤的死亡率,据统计第一次世界大战中为53.3%,第二次世界大战为25%,美军侵朝战争     

腹部损伤死亡的危险因素

2003年卫生部根据30个市和78个县(县级市)死因统计,损伤和中毒为城市居民死因第五位(32.6/10万),农村居民死因第五位(21.5/10万).其中交通伤所占死亡比例在70%以上.创伤多发生于青壮年,伤后对社会的影响甚至超过其他疾病,因此提高其诊治水平的紧迫性远远超过其他疾病.创伤性死亡可按生存概率分为3类 :不可能防止的死亡,生存概率<25%;有可能防止的死亡,生存概率为25%～74%;可防止的死亡,生存概率≥75%.     

腹部损伤的急救

腹部损伤有开放性和闭合性损伤之分,均可出现腹腔内实质脏器损伤、血管损伤、空腔脏器损伤及腹壁软组织损伤.     

汶川地震腹部损伤的诊治

After analyzing the clinical data of 5 injured persons diagnosed with delayed spleen or liver rupture combined with fractures after the Wenchuan earthquake, we found that the abdominal injuries in earthquake were rare but usually very severe. Since almost all the injured persons had multiple injuries, mortality was extremely high. First aid service should be applied in the first 6 to 8 hours. Orderly physical examination and peritoneocentesis in multiple sites are in favor of diagnosis. Reducing the missed diagnosis rate of abdominal injuries is important in raising the rate of successful treatment. Therapy for earthquake injuries should be focused on the most deadly injuries after a thorough examination, besides this, precise employment of control surgery, swift transportation of the injured persons, and prevention and dealing with complications are also important.     

地震灾害致腹部创伤的诊治体会

目的研究特大地震灾害所导致的腹部外伤的分类和预后,总结其救治经验。方法2008年5月12日至22日江油市903医院收治589例地震伤者中24例（4．1％）合并腹部伤,对其伤情资料进行统计分析。结果24例腹部伤中,3例由于严重的胸腹伤在运送至医院途中或到院即死亡,21例收治住院,5例由于严重胸、腹部伤或颅脑损伤在入院后12h内死亡,总病死率33．3％。常见的腹部伤是腹壁挫伤、腹膜后血肿、脾破裂、肝挫裂伤。所有伤者均合并软组织损伤,23例（95．8％）合并其他重要脏器损伤。存活伤者16例,经及时积极救治,预后良好。结论早期甄别伤情、明确诊断,积极抗休克,选择恰当的治疗方式,及时处理合并伤可以有效降低病死率。     

Diagnosis and treatment of abdominal injuries

Results of treatment of 164 patients with combined abdominal trauma were analyzed. It makes sense to evaluate severity of trauma and severity of the patient condition by scales VPKh-MT and VPKh-SP. These scales permit to standardize severity of damages and choose optimum diagnostic and curative algorithm. The emphasis is on early ultrasonic examination of the abdomen in combined trauma. In obscure ultrasonic diagnosis laparoscopy is recommended, in severe or extremely severe condition of patients (over 31 points by scale VPKh-SP)--laparocentesis. Choice and time of surgical interventions must be determined by priority of severity of damage.     

腹部创伤手术后感染并发症48例分析

目的 腹部创伤手术后发生感染并发症的概率高,临床诊治难度大,本文探讨其发生机制及防治策略.方法 回顾性分析第三军医大学附属大坪医院在2005年7月- 2010年12月间收治的腹部创伤手术后发生腹部感染并发症的48例患者,其中男性30例,女性18例,平均年龄38岁;单纯腹部损伤20例,多发伤28例,ISS评分16 ～52...     

震区后方医院快速分检处理腹部损伤

The main causes of early mortality after the earthquake are traumatic shock, hemorrhage and dehydration, and the ratios of shock and hemorrhage are high in patients with abdominal injuries. Prompt triage is very important to persons with abdominal injuries who were rescued in 48 hours after the earthquake. Primary triage should be carried out in the rescue field, and then followed by the secondary triage in the hospital. We improved the efficiency and accuracy of triage by following the principle of "5 steps, 3 categories and 1 indication". Nineteen persons with identified abdominal injuries and unstable vital signs received operation. The false positive rate was 5% (1/19), and the successful rate of the operation was 95% (18/19). During the process of rescue, the lives of the injured persons should be put in the first place. The operation should be performed under the principle of simpleness, rapidity and safeness.