腹部火器伤131例临床救治分析(附9例尸检资料)

目的:分析腹部火器伤的临床特点和救治措施,探讨腹部火器伤救治原则及致死原因。方法:回顾性总结131例腹部火器伤的损伤特点和救治情况;并分析其中9例死亡伤者尸检情况。结果:治愈84例(64.1%),转院21例(16.0%),死亡26例(19.8%);严重并发症主要有:腹腔脓肿21例(16.0%)、切口感染19例(14.5%)、失血性休克30例(22.9%)、感染性休克18例(13.7%)、胃肠瘘18例(13.7%)、急性肾功能衰竭12例(9.2%)。尸体解剖提示死亡原因主要是腹部多脏器损伤合并重症感染、休克、急性肾功能衰竭等。结论:腹部火器伤感染率、死亡率高;及早行剖腹探查术及彻底清创、早期大剂量使用广谱抗生素,防止各种合并症是降低死亡率和提高救治水平的关键。

Clinical Analysis of Therapy of Abdominal Firearm Injuries in 131 Cases (with 9 cases performed autopsy)

Objective:To analyze the clinical features and treatment of abdominal firearm injuries,explore the treatment principle and the lethal reasons. Methods:The characteristics of injury and treatment methods were retrospectly reviewed and summarized for 131 cases with abdominal firearm injuries. and 9 cases performed autopsy. Results:Through the treatment,the therapic effects as followed:84 cases (64.1%) recovered,21 cases(16.0%) transferred and death 26 cases (19.8%).The main severe complications included intra-abdominal abscess in 21 cases(16.0%),wound infection in 19 cases(14.5%),hemorrhagic shock in 30 cases(22.9%),sepsis shock in 18 cases(13.7%),gastrointestinal fistula in 18 cases(13.7%) and acute renal failure in 12 cases(9.2%). According to the autopsy,the mainly cause to death were the early complication,such as severe infection,hemorrhagic or sepsis shock and acute renal failure. Conclusion:It was characterized by high infection rate and high mortality rate of the abdominal firearm injuries.For decreasing the mortality rate,and to improve their cure standards It might be very important to complete debridement,perform exploratory laparotomy and apply the broad-spectrum antibiotics as early as possible,and protect any complication.