重型颅脑损伤为主的多发伤救治策略

目的探讨重型颅脑损伤为主的多发伤的临床特点及救治策略。方法回顾性分析福建医科大学省立临床医学院2012年6月—2016年6月收治的65例重型颅脑损伤合并多发伤患者的临床资料,男性48例,女性17例;年龄16~65岁,平均38.2岁。其中合并腹部闭合性损伤18例,合并血气胸、创伤性湿肺、多发肋骨骨折及心脏挫伤12例,合并骨盆骨折11例,合并严重口腔颌面部损伤9例,合并四肢骨折15例;GCS≤8分,ISS≥16分。结果 65例患者中,恢复良好30例(46.2%),轻度残疾12例(18.5%),重度残疾8例(12.3%),植物生存状态及自动出院6例(9.2%),9例死亡(13.8%)。结论颅脑损伤合并多发伤伤情重且复杂,病死率及致残率高,采用多发伤一体化救治模式及损害控制外科原则,优先处理重型颅脑损伤,结合重症综合治疗,对提高重型颅脑损伤合并多发伤患者的救治成功率有积极意义。

Strategy on the treatment of severe traumatic brain injury combined with multiple injury

Objective To explore the clinical features and treatment strategies for patients with STBI( se-vere traumatic brain injury) combined with multiple trauma. Methods The clinical data of 65 poly-trauma patients with STBI in our department during Jun. 2012 and Jun. 2016 were analyzed retrospectively. Among them 48 cases were male and 17 were female. Ages ranged from 16-65 years with an average of 38. 2 years. Of 65 cases,18 had closed abdominal injury,12 had hemopneumothorax,traumatic wet lung and multiple ribs fracture,11 had pelvic fracture,9 had severe oral and maxillofacial injury,and 15 had limbs fracture,with GCS≤8 and ISS≥16. Results In all the 65 cases,30 were cured(46. 2％),12 cases had mild disability(18. 5％),8 cases had serious disability (12. 3％),6 cases were in plant survival state(9. 2％),and 9 cases died(6. 2％). Conclusion STBI combined with multiple trauma is very severe and complicated with high mortality and morbidity. According to poly-trauma treatment integration,using damage control surgery and treating STBI preferentially combined with ICU comprehen-sive treatment is the key to improve the success rate of treatment of such patients.