重度闭合性腹部交通伤急诊一站式诊治体会

目的探讨重度闭合性腹部交通伤急诊一站式诊治流程及效果。方法回顾性分析65例经急诊一站式诊治重度闭合性腹部交通伤患者的临床资料,强调急诊基础生命支持治疗、病史采集、快速查体、诊断性腹腔穿刺术及急诊一站式辅助检查对诊断重度闭合性腹部交通伤患者的重要性。诊断明确或部分诊断不清而又高度怀疑有腹内脏器损伤者应及时手术治疗;对损伤严重无手术指征者,仅行非手术治疗。结果术前确诊51例,术中确诊14例;手术治疗64例(其中确定性手术治疗31例、损伤控制外科治疗33例)、非手术治疗1例;治愈62例,死亡3例(其中术后死亡2例,1例合并脑疝患者未手术即死亡)。结论急诊一站式辅助检查及优化的诊断、救治流程,有助于重度闭合性腹部交通伤患者早期诊断及早期手术治疗;一站式诊治模式是提高重度闭合性腹部交通伤救治成功率的关键。

One-Stop Diagnosis and Treatment for Severe Blunt Abdominal Traffic Injury in Emergency Department

Objective To explore the process and effect of one-stop diagnosis and treatment mode for severe blunt abdominal traffic injury in emergency department.Methods The clinical data of 65 cases of the one-stop diagnosis and treatment with severe blunt abdominal traffic injury in emergency department were retrospectively reviewed.Base life assistance,medical history gathering,quick physical examination,diagnostic abdominal cavity puncture,and the one-stop auxiliary examination in emergency department were paid more attentions in the diagnosis of severe blunt abdominal traffic injury.The patients who had been definite diagnosed or partly definite diagnosed but highly suspected for severe blunt abdominal traffic injury underwent immediately surgery.No surgery treatment was performed in patients without the indications of operation,though with serious injury.Results Fifty one cases were confirmed before the operation,14 cases in the operation.64 cases received surgical treatment(including 31 cases of certainty surgery and 33 cases of damage control surgery),1 case received the non-surgical treatment.62 cases were cured and 3 cases died(postoperative death in 2 cases,death from brain herniation in 1 case without surgery).Conclusion The one-stop auxiliary examination and the optimized diagnosis and treatment processes in emergency department can improve the early diagnosis and surgical treatment of severe blunt abdominal traffic injury,and increase the successful rate of treatment.