重型颅脑外伤合并腹部脏器损伤延迟加重的诊治

目的　探讨重型颅脑外伤合并腹部脏器损伤延迟加重的诊断和治疗。　方法　回顾 4年来收治的 3 7例重型颅脑外伤合并腹部脏器损伤体征延迟出现并进行性加重的患者资料 ,分析此类患者腹部手术前后损伤严重度评分 (ISS)和简明损伤定级 (AIS)差异、死亡及并发症发生率与伤后是否直接入ICU的关系。　结果　伤后直接入ICU与未直接入ICU患者格拉斯哥昏迷评分 (GCS)、ISS、AIS比较 ,差异无显著性意义 (P >0 .0 5) ,患者腹部手术前后ISS及AIS差异有非常显著性意义 (P =0 .0 0 0 ) ,死亡率与伤后是否直接入ICU密切相关 (P =0 .0 18) ,并发症发生率与是否直接入ICU差异无显著性意义 (P =0 .0 67)。　结论　重型颅脑外伤合并腹部脏器损伤延迟加重的患者伤后直接入ICU ,适当放宽手术指征可能有助于提高抢救成功率

Diagnosis and treatment of severe head trauma with delayed abdominal injuries

Objective To discuss diagnosis and treatment of severe h ead trauma with delayed abdominal injuries. Methods Data of 37 cases of severe head trauma with delay abdominal injuries within four years w ere analyzed retrospectively. Scores of injury severity score (ISS) and abbrevia ted injury scale (AIS) before and after abdominal operation were calculated and compared. We also determined whether the complication and the mortality were rel ated to those patients admitted to ICU or not. Results There was no significant difference in Glasgow coma score (GCS), ISS and AIS between p atients admitted to ICU and those not after injury ( P >0.05). There was a ver y significant difference in ISS and AIS before abdominal operation compared with those after operation ( P =0.000). Mortality rate was closely related to post traumatic admission to ICU ( P =0.018). However, there was insignificant relat ionship between complication and admission to ICU ( P =0.067). Conc lusions Outcome of severe head trauma with delayed abdominal injuries can be improved with earlier admission to ICU and early operation.