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目的探讨严重多发伤的临床特点及救治措施。方法对1999年9月～2006年3月救治的413例严重多发伤进行回顾性分析。结果本组病例的临床诊断均符合多发伤标准,创伤严重度评分(ISS)>16,平均23.5±8.2。急诊手术322例次,其中64例在1次麻醉下分组同台完成了2个以上部位的手术。重症监护病房(ICU)平均住院(21.8±5.6)天。临床治愈289例(70%),致残67例(16.2%),死亡57例(13.8%)。结论诊断性胸腹腔穿刺和床旁B超检查快速、简洁、敏感。病情允许的伤者可考虑头、胸、腹同时CT扫描。手术顺序应按其致命性严重程度决定,尽可能在一次麻醉下分组同台处理不同部位的损伤。主动实施损伤控制性手术(DCO)策略,术后均进入ICU,可有效降低病死率。
Objective To investigate the clinical features and treatment of severe multiple trauma. Methods A retrospective analysis was performed on 413 cases of severe multiple injuries treated from September 1999 to March 2006. Results The clinical diagnosis of this group of patients met the criterion of multiple trauma. The severity of injury (ISS)> 16, with an average of 23.5 ± 8.2. Emergency surgery 322 cases, of which 64 cases under the same anesthesia group on the same stage to complete more than two parts of the operation. The intensive care unit (ICU) was hospitalized an average of (21.8 ± 5.6) days. 289 (70%) were clinically cured, 67 (16.2%) were disabled and 57 (13.8%) died. Conclusion Diagnostic thoracentesis and bedside B-ultrasound are fast, concise and sensitive. Wounded allowed to consider the condition of head, chest, abdomen, CT scan at the same time. The surgical procedure should be based on the severity of their fatal decisions, as far as possible under the same group of anesthesia to treat different parts of the same injury. Take the initiative to implement the damage control surgery (DCO) strategy, after all were admitted to the ICU, can effectively reduce the case fatality rate.