严重多发伤237例救治分析

目的 探讨严重多发伤的损伤特点及诊治方法。方法 回顾分析我院救治的237例严重多发伤的临床资料。非手术治疗l0例，手术治疗227例。结果 伤后确诊时间平均3．8h，漏诊率7．6％。损伤脏器依次为：四肢、腹、胸、头等。休克发生率83．1％，发生脓毒血症23例(9．7％)，急性肺损伤及ARDS49例(20，7％)，MODS21例(8，9％)，应激性溃疡52例(22．4％)。治愈196例(82，7％)。死亡41例(17，3％)。结论 及时控制出血，减轻缺血缺氧损害；正确掌握手术时机、及时准确地手术；维护重要脏器功能，减少内脏并发症是严重多发伤救治的关键环节。

MANAGEMENT OF INJURY IN PATIENS WITH SEVERE MULTIPLE TRAUMA: A REPORT OF 237 CASES

Objective To explore injury characteristics and management for severe multiple trauma. Methods The clinic data of 237 patients with severe multiple trauma treated in our hospital from 1997 to 2002 were analyzed retrospectively. 227cases of which with operative treatment and 10 cases with nonoperative treatment. Results Average time of final diagnosis after injury was 3.8 hours. The rate of missed diagnosis at early stage was 7.6 %. Injured organs were Iimbs, abdomen, chest and head in turn. Incidence of shock was 83.1%, serious sepsis on 23 cases(9.7%), acute Iung injury and ARDS on 49 cases (20.7%), MODS on 21 cases (8.9%) and stress ulcer on 52 cases (22.4%). Of all the patients, 196 (82.7%) were cured, 41 (17.3%) died. ConcIusion The key links in treatment on serious multiple trauma are as follows: Controlling hemorrhage promptly, relieving ischemia and hypoxia, mastering accurately operation occasion and operation methods, maintaining function of the important organs, decreasing complication of internal organs.