| BackgroundWith the development of society, in traffic accidents and other factors complicated the role of injury, severe abdominal trauma cases is increasing. Early surgical intervention to a variety of trauma patients prone to organ failure. Especially in severe trauma with severe abdominal trauma, often complicated by shock, severe physiological disorders and functional disorders of metabolism, thus, patients with low body temperature, coagulation disorders and acidosis triad of the body in a physiological limit state, These are not the initial cause of trauma, but patients in the molecular, cellular and hemodynamic imbalance aspects of the performance of relatively late. Obviously these three factors is extremely complex relationship between one another Aggravated triangle of death, leading to metabolic failure and death.Thus, at low temperature, acidosis and coagulopathy vicious cycle between the three patients in the limit state of life, this time of definitive surgery can not stand for a long time. To break this vicious cycle, trauma surgeons practice a system of treatment that is damage control surgery (damage control surgery, DCS), the basic idea is that through a variety of temporary measures to maintain the basic state of life of patients through the recovery correction various metabolic disorders and improve the patients ability to tolerate definitive surgery, the last definitive surgery or several times by the certainty of surgery to save the lives of patients.ObjectiveThis study was designed to summarize a large number of clinical cases, to obtain complete data, analysis of merger severe abdominal trauma with multiple injuries and damage control features of the condition of the clinical effects of surgical treatment for these patients the treatment principles, treatment options, timing of surgery, surgical decision-making basis and prognosis.MethodsRetrospective analysis of the Guangzhou Military Region, Guangzhou General Hospital from January 2006 to December 2010 where 196 cases with abdominal trauma with severe multiple trauma patients with clinical data, the use of injury severity score (injuryed severity score, ISS) of the patients were classified assessment preoperative ISS score of 16 to 24 were divided into A group,25 to 34 were divided into group B,≥35 were divided into C, by age, ISS score, site of injury, surgical site, deterministic operation time, blood transfusion, hospital stay, complication rate, mortality and other indicators were statistically analyzed to assess the effect on patients.Results1,this group of cases,150 cases of male, female 46, male to female ratio was 3.26:1. Age from 14 to 71 years, average age (36.58±12.40) years. High age of 20 to 40 years old, accounting for 61.4%. The causes of injury in traffic accidents as the first reason, a total of 112 patients (57.1%), followed by high fall injury, a total of 36 cases (18.4%), and the remaining 26 patients were injured by heavy objects (13.3%), knife stabbing 14 cases (7.1%), blast injury in 4 cases (2.0%), machine trauma in 4 cases (2.0%). A total of 568 site of injury, average 2.90, including:head 69, face 68, neck 16, chest 58,211 abdominal, pelvic 29, upper 49, lower limb 68. ISS score of 16 to 73 minutes, the average (29.42±11.76) points. Cured, improved 162 cases (82.65%); death and dying left the hospital 34 patients (17.35%). All cases, major complications:19 cases of hemorrhagic shock, respiratory failure,7 cases of multiple organ failure in 9 cases,15 cases of lung infection, intestinal leakage in 7 cases,11 cases of intestinal obstruction, gastrointestinal bleeding,1 case other parts of the infection in 5 cases. Death and survival in patients compared two groups of indexes, falling from height injury death group the proportion of patients with complications was significantly higher than the survival group, head injury was the major fatal injury death group was significantly higher than the average ISS score survival group The main cause of death was hemorrhagic shock, multiple organ dysfunction syndrome (multiple organ dysfunction sydrome, MODS) and central respiratory failure.2,divided into 2 groups according to prognosis:A group of 164 patients for the survival group, mean patient age was 37.00±12.76 years, falls were the number of cases to 22 cases, compared to 25.61%, traffic injuries were the number of cases to 89 cases, compared to 46.34%, head injury cases number of 60 cases, compared to 36.59%, ISS average of 25.75±7.71, number of complications were 52 cases of patients, compared to 31.71%.B group,32 cases of death, with an average age of 34.41±10.22 years, falls were the number of cases to 14 cases, compared to 41.18%, traffic injuries were the number of cases to 23 cases, compared to 29.41%, head injury cases number of 18 cases, compared to 53.94%, ISS average was 48.22±11.02, number of complications occurred in 22 cases patients, a ratio of 64.71%. After statistical analysis, A, B groups the average age of patients, the number of cases of traffic injury patients was not significantly different (P> 0.05), the number of cases of patients falling from height, number of cases of brain injury, ISS, on average, complications Comparing the number of cases a significant difference (P<0.05).3,according to ISS score was divided into 3 groups:A group of 82 patients 16 to 24 minutes, age 37.71±12.86 years, mean ISS score was 19.85±2.27 points, number of injury site 1.87±0.75, number of surgical site 1.40±0.56, definitive surgery after injury time was 8.57±3.31 days, blood transfusion was 183.54±253.62ml, length of stay was 21.45±7.30 days, the complication rate was 9.8%, mortality 4.88%.B group 25 to 34 minutes in 76 cases, age 36.76±11.93 years, mean ISS score was 30.15±3.14 points, damage several parts of 1.89±0.67, number of surgical site 1.47±0.62, definitive surgery after injury time was 14.93±3.87 days, blood transfusion was 511.84±550.14ml, length of stay was 35.16±15.59 days, the complication rate was 44.7%, mortality rate was 7.89%.C group 38 patients≥35 group, age 33.76±12.13 years, mean ISS score was 48.62±10.74 points, number of injury site 2.13±0.75, surgical site was 1.53±0.69, definitive surgery after injury time was 21.21±4.89天, blood transfusion was 855.26±769.59ml, length of stay 45.66±11.57 days, the complication rate was 84.2%,63.16% mortality.After statistical analysis, A, B, C three groups of age, injury site, the surgical site was no significant difference (P> 0.05), ISS score, blood transfusion, hospital stay, deterministic operation time, complications and mortality compared significant difference (P<0.05).Conclusion: 1,in this group of patients, the combination of severe abdominal trauma patients with multiple injuries the high age of 20 to 40 years, traffic accidents as the first cause of injury, the total success rate was 82.65%.2,in this group of patients, with the ISS score increases, the patient treatment process is more complex and longer duration. ISS value of 25 to 34 group, the incidence of complications was 44.7%, ISS≥35 group of cases the value of 84.2% mortality, so we should be more focus on the treatment of more than 25 cases of ISS values, and to reduce The range of complications and mortality in patients.3,with the injury severity score on the merger will help the clinical abdominal trauma patients with severe multiple trauma injuries evaluated to determine timing of surgery, treatment options and prognosis.4,this study demonstrated that combined use of DCS treatment of abdominal trauma patients with severe multiple injuries, you can play to improve the survival rate of good results. |
PDF Full Text Request