剖腹探查在高原地区腹部外伤中的临床应用研究

目的研究剖腹探查在高原地区腹部外伤中的临床应用,以提高剖腹探查的阳性率。方法临床入选411例腹部外伤患者,分别分析剖腹探查阳性患者组与剖腹探查阴性患者组的白细胞计数及D-二聚体、C反应蛋白的水平以及主要的临床表现情况。结果本研究探查阴性率为40.88%,探查性阳性率为59.12%,其中肝脾破裂62例,肠破裂51例,后腹膜血肿50例,肠系膜裂伤及血肿49例,肠挫伤31例,病死率为1.94%。在白细胞计数方面,探查阴性组与探查阳性组之间没有统计学差异（P〉0.05）;而在C反应蛋白及D-二聚体的水平方面,探查阴性组与探查阳性组之间具有统计学差异,且阳性组要显著高于阴性组（P〈0.05）。而在腹内脏器疝出和腹痛临床表现方面,探查阴性组与探查阳性组之间均无统计学差异（P〉0.05）;而在气腹、休克、腹穿阳性、腹膜炎及消化道出血等临床表现方面,探查阳性组明显较探查阴性组发生率高（P〈0.05）。结论 C反应蛋白及D-二聚体水平、气腹、休克、腹穿阳性、腹膜炎及消化道出血等临床表现方面可能为临床选择剖腹探查提供一定的依据,据此可以尽可能的避免一些不必要的医疗损伤。

Clinical application of laparotomy in abdominal trauma on plateau

Objective To investigate the clinical application of laparotomy in abdominal trauma on plateau and to improve the positive rate of laparotomy.Methods Four hundred and eleven patients with abdominal trauma were selected.The white blood cell count,D-dimer,C-reactive protein and clinical manifestations of laparotomy-positive group and laparotomy-negative group were compared.Results The laparotomy-positive rate was 59.12%,the laparotomy-negative rate was 40.88%.There were 62 cases of spleen and hepatic rupture,51cases of intestinal rupture,50 cases of retroperitoneal hematoma,49 cases of mesenteric rupture and hematoma and 31cases of intestinal contusion,the case fatality rate was 1.94%.These was no significant difference in the white blood cell counts between the two groups（P0.05）.The levels of C-reactive protein and D-dimer in laparotomy-positive group were higher than those in the laparotomy-negative group（P0.05）.These was no significant difference in the clinical manifestations of hernia and abdominal pain between the two groups（P0.05）,however,the occurrences of pneumoperitoneum,shock,paracentesis positive rate,peritonitis and gastrointestinal bleeding were higher in laparotomy-positive group than those in laparotomy-negative group（P0.05）.Conclusion C-reactive protein,D-dimer levels,clinical manifestations of pneumoperitoneum,shock,paracentesis positive rate,peritonitis and gastrointestinal bleeding may provide certain references for taking abdominal laparotomy in clinics.Unnecessary medical injury can be avoided after taking these references in to consideration.