53例严重多发伤患者的急救诊治临床分析

［摘要］目的　探讨严重多发伤患者的急救诊治策略，为以后类似病例的临床急救诊治提供一定参考价值．方法　对六安市第一人民医院于2014年3月至2015年9月收治的53例严重多发伤患者的临床资料进行分析．结果　本组53例严重多发伤患者早期漏诊4例，漏诊率7.5%；接受手术治疗51例（96.2%），非手术治疗2例（3.8%）；最终成功救治45例（84.9%），死亡8例（15.1%）．死亡的8例患者中有3例死于重型颅脑损伤，分别有2例死于多器官功能障碍综合征和脓毒症，1例死于休克；15例主胸腹部损伤患者经接受损伤控制策略相关处理后未发生死亡病例，均痊愈出院．本组患者仅PCT在治疗第2d有所增加外，但之后也逐渐降低，CRP、IL-6及IL-10三项均呈递减趋势，至第7天与第1天比较均差异有统计学意义（P＜0.01）．结论　在充分掌握严重多发伤临床特点的基础上，尽早地对患者伤情做出准确诊断并最大程度避免误诊，同时高度重视院前及院内的急救工作，合理安排抢救程序并对致命性损伤实施优先处理以及密切关注与控制相关并发症病情进展是提高本病症患者抢救成功率的关键．

The Clinical Analysis of 53 Patients with Severe Multiple Trauma

［Abstract］Objective To investigate the diagnosis and treatment of severe MT patients， and to add a reference for similar cases. Methods　From March 2014 to September 2015， the clinical data of 53 patients with severe MT in Liu'an First People’s hospital were retrospectively analyzed. Results　Four out of 53 cases of severe MT were missed diagnosis（missed diagnosis rate: 7.5%）；51 cases（96.2%）received surgical treatment；2 cases （3.8%）were treated by non operation， 45 cases（84.9%） were treated successfully， and 8 cases（15.1%） died. Among the 8 patients， 3 died of severe craniocerebral injury，2 cases died of MODS and sepsis，and 1 cases died of shock. Fifteen cases of primary thoracic and abdominal trauma patients with DCS after treatment were cured and discharged，among which PCT in the treatment of 2 d increased only at the beginning then gradually reduced after. CRP， IL-6 and IL-10 all showed a trend of decline. Compared with 7 d and 1 d， significant difference was shown （P＜0.01）. Conclusion　By clearly knowing the clinical characteristics of severe MT， accurate diagnosis should be made to avoid misdiagnosis. At the same time， we should pay more attention to the emergency treatment and the treatment of fatal injury.