损伤控制外科技术在严重肝外伤患者治疗中的应用

目的：评估损伤控制外科（ DCS）技术在严重肝外伤患者治疗中的应用及护理。方法回顾性分析2008年1月-2012年12月83例采用DCS方法治疗及护理的Ⅳ、Ⅴ级严重肝外伤患者的基本资料。护理干预包括液体复苏、致死三联征和术后并发症防治。以同期非DCS治疗的Ⅳ、Ⅴ级的31例肝外伤患者作为对照组。结果 DCS组和对照组病死率分别为25．3％和51．6％，两组比较差异有统计学意义（χ2＝7．13，P＜0．01），患者主要死于创伤性凝血病。 DCS组和对照组患者腹腔间室综合征的发生率分别为6．0％，19．4％，膈下脓肿的发生率分别为7．2％，22．6％，两组比较差异均有统计学意义（χ2值分别为4．60，5．27；P＜0．05）。结论采用DCS治疗严重肝外伤合并致死三联征的患者可明显提高患者生存率。护理干预重点为术前限制性液体复苏；ICU阶段纠正凝血障碍、低体温和酸中毒；重视减少术后并发症的护理措施。

Application of damage control surgery in the treatment of severe liver trauma patients

Objective To investigate the clinical application and nursing effect of damage control surgery （ DCS ） in treating patients with severe liver trauma .Methods A retrospective study was used to investigate 83 patients with severe liver trauma （ grade Ⅳ, and Ⅴ） from January 2008 to December 2012 associated with the lethal triad of coagulopathy , hypothermia , and acidosis treated by DCS .Nursing intervention included fluid resuscitation , care of lethal triad and postoperative complications .And the control group was 31 patients with liver trauma of grade Ⅳand Ⅴwho had be treated without DCS .Results The mortality rate was 25.3%and 51.6% in the DCS group and the control group , and the difference was statistically significant （χ2 =7.13, P＆lt;0.01）.The main cause of death was coagulopathy .The incidence of abdominal compartment syndrome was respectively 6.0% and 19.4% in the DCS group and the control group , the incidence of subdiaphragmatic abscess was 7.2%and 22.6%, and the differences were statistically significant （χ2 =4.60, 5.27, respectively;P＆lt;0.05）.Conclusions DCS for patients with severe liver trauma can obviously increase their survival rate .The point of nursing intervention was limited fluid resuscitation before the surgery , correction of coagulopathy , hypothermia and acidosis during ICU as well as prevention and management of postoperative complications after the surgery .