应用损害控制外科原则治疗严重多发伤合并连枷胸的效果观察

摘要

Objective To explore the effect of damage control surgery principle in the treatment of severe multiple injury combined with flail chest.Methods Eighty-six patients with severe multiple trauma and flail chest,who were treated in the First People's Hospital of Wuxue from Mar.2013 to Sep.2015,were selected and divided into the study group(48 cases who were treated with damage control surgery after Jun.2014) and the control group (38 cases who were not treated with damage control surgery before Jun.2014).The success rate of treatment and the incidence of complications were observed in the two groups.The depth of inspiratory capacity (IC),forced vital capacity (FVC),forced expiratory volume (FEV1),and total lung capacity (TLC) at 3 months after discharge were compared.Results The lethal triad in the study group was less than the control group,and the difference was statistically significant (P<0.05).Forty-four cases were successfully treated in the study group,with the success rate of 91.7%.In the control group,28 cases were successfully treated,and the success rate was 73.7%.The success rate of the study group was significantly higher than that of the control group (P<0.05).The complication rate was 16.7% in the study group and 42.1% in the control group,and the incidence of complications in the study group was significantly lower than that in the control group (P<0.05).IC,FVC,FEV1 and TLC were significantly higher in the study group than those in the control group (P<0.05) at 3 months after discharge.Conclusion Using damage control surgery principle in treatment of severe multiple injury with flail chest can make obtain fast treatment,effectively avoid the stress response to trauma and obtain a high cure rate.%目的 探讨应用损害控制外科(damage control surgery,DCS)原则治疗严重多发伤合并连枷胸的治疗效果.方法 选择2013年3月~2015年9月笔者医院收治的严重多发伤合并连枷胸患者86例进行回顾性研究,其中2014年6月前未应用DCS原则治疗的患者38例作为对照组,之后应用DCS原则治疗的患者48例作为研究组.观察两组救治成功率、住院期间并发症发生情况.比较出院后3个月深吸气量(IC)、用力肺活量(FVC)、第1秒用力呼气容积(FEV1)和肺总量(TLC).结果 研究组患者致死三联征,即低体温、凝血功能紊乱和代谢性酸中毒情况均少于对照组,差异有统计学意义(P<0.05);研究组救治成功44例,成功率91.7%.对照组救治成功28例,成功率73.7%,研究组救治成功率显著高于对照组(P<0.05).研究组并发症发生率为16.7%,对照组并发症发生率为42.1%,研究组住院期间并发症发生率显著低于对照组(P<0.05).研究组出院后3个月IC、FVC、FEV1、TLC均显著高于对照组(P<0.05).结论 应用DCS原则治疗严重多发伤合并连枷胸能使治疗简明、快捷,有效避免创伤的应激反应,救治成功率较高.