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直接进急诊手术室抢救严重创伤77例 |
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方先业 杨培生 刘牧林
【摘要】 目的 总结1989~1998年10年间,直接进手术室抢救严重创伤病人的经验。 方法 充分发挥急诊外科手术的优势,对需紧急手术来挽救生命的严重创伤病人77例(AIS~ISS评分均>60),利用床边检查,明确诊断,在复苏和抗休克的同时及早施行各类手术。本组紧急开颅手术8例,紧急开胸12例,紧急开腹30例,血管手术6例,联合手术等21例。 结果 手术前和手术中复苏18例,复苏成功10例(55.6%)。手术及手术后死亡23例,总死亡率29.9%。 结论 积极创造急诊手术条件,掌握好适应证,把诊断和治疗、复苏、抗休克和紧急手术有机结合起来,直接进手术室组织抢救,能提高严重创伤的抢救成功率。 【关键词】 创伤和损伤 复苏术 急救
Management of Critically Injured Patients in Emergancy Operating Room
FANG Xianye, YANG Peisheng, LIU Mulin. Dept. of Emergency Surgery, Affiliated Hospital of Bengbu Medical College, Anhui, 233000
【Abstract】 Objective To evaluate the effects of resuscitation, emergency operation and support treatment on seriously injured patients from 1989 to 1998 in emergency operating room (EOR). Methods There were 77 patients (AIS -ISS score >16) who needed emergency medical serves including basic life support, anti-shock treatment, and surgical interventions. Eight patients received craniotomy, 12 received thoracotomy, 30 laparotomy, 6 vascular operation., 21 multiple-sites operations. Results Among the 18 cases who underwent resuscitation preoperatively or intraoperatively, 10 (55.6%) survived. Twenty-three cases died in operating room or after operation with a total mortality rate of 29.9%. Conclusions Early and prompt surgical treatment in EOR is of beneficial effects on critically injured patients. 【Key words】 Wounds and injuries Resuscitation First aid
1989~1998年10年间施行急诊手术2 487例,其中由急诊室直接进入手术室施行紧急手术抢救的严重创伤77例,死亡23例,抢救成功率为70.1%。现报告如下。
资料与方法 本组77例中男51例,女26例;年龄3~77岁,平均26.9岁。受伤原因:交通伤33例,刀刺伤19例,枪击伤5例,坠落伤4例,工伤10例,其他伤6例。受伤部位:多发伤37例;单一的腹部、胸部、头、颈、四肢和皮肤等处创伤40例;有内脏伤者68例。受伤脏器:1个35例;2个17例;2个以上16例。就诊时血压(收缩压)均低于75.0 mmHg(1 mmHg=0.133 kPa),有12例测不出血压。创伤严重度评分(AIS-ISS)均>16。受伤至就诊时间10分钟~3小时;就诊至入手术室时间5~20分钟。手术前施行心肺复苏11例,手术中施行心肺复苏7例,复苏成功10例(55.6%)。手术方法和结果:紧急开颅8例;紧急开胸12例;紧急开腹30例;血管手术6例;清创3例。胸腹联合手术11例,胸颅联合手术4例,颅腹联合手术3例。手术中死亡12例,手术后死亡11例,手术死亡[1] [2] 下一页 上一个医学论文: 249例重型颅脑损伤救治策略分析 下一个医学论文: 颅脑火器伤的急救措施
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