多发伤严重并发症的监护治疗

目的总结ICU中多发伤严重并发症的发生率和救治经验。方法回顾性分析第三军医大学大坪医院重症医学科2013年1月～2016年1月治疗的150例严重多发伤患者的临床资料,总结分析多发伤严重并发症,如创伤性休克、创伤致死三联征、脓毒症、腹腔间隙综合征、急性呼吸窘迫综合征、急性肾损伤、急性胃肠损伤的发生率以及监护治疗措施和结局。结果本组共150例,发生创伤性休克109例(72.7%);创伤致死三联征89例(59.3%),其中发生弥散性血管内凝血7例(4.7%),死亡3例(2%);脓毒症41例(27.3%),其中脓毒性休克14例(9.3%);腹腔间隙综合征2例(14.7%),死亡2例(1.3%);急性呼吸窘迫综合征36例(24.0%),死亡1例(0.6%);急性肾损伤37例(24.7%);急性胃肠损伤53例(35.3%)。ICU住院天数5～36d,平均8.9d。顺利转科136例(90.7%),自动出院8例(5.3%),死亡6例(4.0%)。结论进入ICU的多发伤患者并发症发生率高,以创伤性休克为主,而弥散性血管内凝血的死亡率最高,其次是腹腔间隙综合征,多发伤患者进入ICU实施严密监测,对并发症的防治十分重要。

Monitoring and treatment of severe complications of multiple-trauma patients in intensive care unit

Objective To make a summary of the incidence and treatment experience of multiple-trauma patients with serious complications in intensive care units. Methods The clinical data of 150 multiple-trauma patients with serious complications(such as traumatic shock,trauma triad of death,sepsis,abdominal compartment syndrome,acute respiratory distress syndrome,acute kidney injury and acute gastrointestinal injury) in ICU of Daping Hospital from Jan.2013 to Jan.2016 were retrospectively analyzed and the incidence,clinical monitoring and treatment and the cure rate of these patients were summarized. Results Among the 150 patients,109 had traumatic shock (72.7%);89 had trauma lethal triad (59.3%),including 7 cases of disseminated intravascular coagulation (4.7%), and 3 deaths(2%);41 cases had sepsis(27.3%),including 14 cases of sepsis shock(9.3%);22 cases had abdominal compartment syndrome (14.7%),including 2 deaths (1.3%);36 cases had acute respiratory distress syndrome (24.0%),including 1 death(0.6%);37 cases had acute kidney injury(24.7%),and 53 had acute gastrointestinal injury (35.3%).The ICU stay of 150 patients ranged 5 to 36 days,with an average of 8.9 days.Totally 136(90.7%) of them were smoothly transferred to other departments,and 8 cases (5.3%) were discharged and 6 cases (4%) died. Conclusion There is a high rate of complications in multiple-trauma patients.Most of them suffer from traumatic shock.Meanwhile,the mortality rate of disseminated intravascular coagulation is the highest among the patients,and abdominal compartment syndrome has the second highest mortality rate.Therefore,it is important to keep close monitoring on the multiple-trauma patients for the prevention and treatment of the complications.