腹部闭合性外伤与开放性外伤的围手术期临床特征分析

目的分析腹部闭合性外伤与开放性外伤患者围手术期的临床特征,比较两者在外科手术救治过程中的差别。方法回顾性分析2011年1月至2017年12月87例腹部外伤手术患者的临床资料,根据受伤后有无腹部开放性伤口将患者分为闭合组(n=41)和开放组(n=46).使用统计学软件SPSS 26.0进行统计学分析,正态分布的计量资料以平均值±标准差(x±s)表示,组间比较采用t检验。非正态分布的定量资料以中位数M(四分位间距IQR)表示,组间比较采用秩和检验。以P<0.05为差异具有统计学意义。结果致伤因素中,闭合组主要致伤原因为车祸伤,占46.3%,开放组主要致伤原因为刀刺伤,占56.5%。多发伤在闭合组和开放组中分别占58.5%、23.9%0闭合组与开放组相比,术前中性粒细胞与淋巴细胞之比(3.31 vs.2.35)、住院时间(12d vs.9 d)、术中出血量(650 ml vs.400 ml)、伤口乙级愈合(34例vs.28例)、术中输血(38例vs.33例)、肠道-腹壁造痿(25例vs.37例)、术后并发症≤Ⅱ级(23例vs.36例),差异均具有统计学意义(P<0.05)。结论腹部闭合性外伤与开放性外伤具有不同的临床特征,总体而言,闭合性损伤患者病情较重,手术难度大,术后并发症较严重,围手术期管理更复杂,闭合性外伤应当采取专门的诊疗方案。

Analysis of perioperative clinical characteristics of blunt abdominal trauma and open trauma

Objective To analyze the perioperative clinical characteristics of patients with blunt abdominal trauma and open trauma,and to compare the differences during the clinical treatment process.Methods A retrospective analysis method was used to collect clinical data of 87 patients with abdominal trauma between January 2011 and December 2017.Patients were divided into blunt trauma group(n=41 cases)and open trauma group(n=46 cases)according to whether there were open abdominal wounds.Statistical software SPSS26.0 was used for data analysis.Measurement data of normal distribution was expressed as(x±s),and t-test was used for comparison between groups.Nonnorm ally distribution quantitative data are showed by the median(interquartile range IQR),and the rank sum test was used for comparison between groups.P<0.05 was considered as statistically significant difference.Results Among the injury factors,the main cause of injury in the blunt group was car accident injury,accounting for 46.3%,and the main cause of injury in the open group was knife stabbing,accounting for 56.5%.Multiple injuries were 58.5%in the blunt group and 23.9%in the open group,respectively.Compared with the open group,the ratio of neutrophils to lymphocytes before operation(3.31 vs.2.35),hospitalization time(12 d vs.9 d),intraoperative blood loss(650 ml vs.400 ml),and grade II wound healing(34 cases vs.28 cases),intraoperative blood transfusion(38 cases vs.33 cases),intestinal-abdominal wall fistula(25 cases vs.37 cases),postoperative complications≤grade Ⅱ(23 cases vs.36 cases),the differences were statistically significant(P<0.05).Conclusion Blunt abdominal trauma and open trauma have different clinical characteristics.In general,patients with blunt trauma are more severely injury,difficult to surgery,more serious postoperative complications,and more complicated during perioperative management.The diagnosis and treatment strategy of blunt trauma should be prepared differently.