514例腹部严重多脏器伤分析

目的 提高早期多发伤伴腹部严重多脏器的诊断和手术治疗水平。方法 ７年多收治严重腹部多脏器伤５１４例，男４２１例，女９３例。伤因主要为效能伤、高处坠落伤、斗殴伤等。ＩＳＳ≥１６，最高６６，平均３１．５。闭合伤４２７例，开放伤８７例剖腹手术４３９例，腹内主要脏器损伤依次是脾、肝、肾、胃、大小肠、结肠、直肠等。结果 存活４７３例，入院时血压为零被抢救成功７２例，由于首次手术处置不当或遗漏损伤脏器再次手术

Severe Abdominal Multiple Organ Injuries: Analysis of 514 Cases

Objective To improve the level of early diagnosis and operating treatment of abdominal multiple organ injuries. Methods From January 1991 to November 1998, 514 patients with abdominal multiple organ injuries were treated in our unit. The causes of injuries were mainly road traffic accidents, fall and assault etc. All patients ISS were greater than 16, the highest ISS and the mean ISS were 66 and 31.5 respectively. Closed wounds were in 427 cases and open wounds in 87 cases. In this study, 439 cases underwent laparotomy. The main intra-abdominal organ injuries included spleen, liver, kidney, stomach bowel, colon and rectum etc.Results Of 473 cases who survived, 72 cases showed no detectable blood pressure on admission were brought back to life, 12 cases were reoperated on due to missed injuries or inadequate management at the initial operation. Forty one cases died. The mortality was 7.9%. Most of the deaths were due to hemorrhagic shock .Conclusions Under urgent conditions, consuming diagnostic procedures are not allowed when the patients' hemodynamics is stable. Modern diagnostic technique should be used to avoid polytrauma. Laparotomy should be performed actively, for prolonged contamination due to gastro-intestinal rupture is more harmful than negative exploration. An operative principle is that saving life is the first, remaining organ the second.