损害控制策略在以腹部损伤为主的多发伤救治中的应用

目的探讨应用损害控制策略（DCS）在以腹部损伤为主的多发伤救治中的治疗效果,总结救治经验,提高救治水平。方法对2007年7月~2010年7月期间126例以腹部损伤为主的多发伤的救治进行回顾性分析,按照创伤严重度评分（ISS）,分为一般损伤组（ISS≤35分）67例和严重损伤组（ISS〉35分）59例,其中对59例严重损伤患者应用损伤控制技术,占46.8%。复苏期间监测两组患者的乳酸清除时间、体温恢复时间、凝血功能,同时对两组腹部术后并发症的发生率、DIC发病率和死亡率亦进行比较。结果复苏期间两组患者的血清乳酸清除时间、体温恢复时间、凝血功能进行监测比较,结果显示差异无显著性（P〉0.05）,两组术后并发症的发生率、DIC发病率和死亡率的比较,结果亦无显著差异性（P〉0.05）。结论在以腹部损伤为主的多发伤救治中,合理实施损害控制策略可有效降低其死亡率和剖腹术后腹部并发症发生率;准确合理地选择适应证、快速有效的简化手术、ICU复苏支持和恰当无延误地实施再手术是DCS成功的关键。

The application of damage control strategy in the remedy of patients of abdominal injury with multiple trauma

Objective To investigate the effect of damage control strategy（DCS）in the remedy for patients of abdominal injury with multiple trauma and to summarize the experience for the improvement of rescue.Methods Data of 126 patients of abdominal injury with multiple trauma from July 2007 to July 2010 were analyzed retrospectively.All patients,according to injury severity score（ISS）,were divided into common damage group（ISS≤35） which included 67 patients and severe damage group（ISS〉35） which included 59 cases.DCS was put into practice among the severe damage group of 59 cases（46.8%）.Lactic acid clearance time,recovery time of body temperature,coagulation in the duration of resuscitation and disseminated intravascular coagulation（DIC） morbidity,mortality of postlaparotomy complication were observed and compared between two groups respectively.Results There were no significant differences in the lactic acid clearance time,recovery time of body temperature,and coagulation（P〉0.05）.The occurrence rate of complications,DIC morbidity and mortality between two groups showed no significant differences（P〉0.05）.Conclusion In the remedy for patients of abdominal injury with multiple trauma,rational application of damage control strategy could effectively lower incidence rate of postlaparotomy complications and mortality.Proper selection of DCS,prompt,effective and simplified surgery,resuscitation and support from the intensive care unit（ICU）,and appropriate time for the second surgery are essential to the success of DCS.