严重多发伤骨折确定性手术的时机选择

摘要

目的 对一组严重创伤患者生命体征C反应蛋白(CRP)、肌酸激酶(CK)、肌酸激酶同功酶(CKMB)活性、血糖(GLU)等指标的动态观察,探讨骨折确定性手术的时机.方法 本组患者入院后评定ISS得分,将ISS≥16分(16～40分)者纳入观察对象,动态观察血压(BP)、呼吸(R)、体温(T)、动脉血氧分压(PaO2)指标,并于伤后1、3、7、14d分别检测外周血中CRP、CK、CKMB、GLU等指标浓度.于生命体征平稳、CRP、CK、CKMB、GLU等指标正常或接近正常1～2d后行确定性骨折手术.结果 本组29例均得到随访,其中8例电话随访,随访时间9～24个月.损害控制性手术控制了绝大部分患者的出血和污染,纠正了休克.确定性手术后恢复良好.10例(12处)开放性和13例(24处)闭合性骨折行内固定肢体均无术后切口感染.结论 患者的生命体征、血氧饱和度(SpO2)、CPR、CK、CKMB、GLU等指标持续下降或接近正常值可作为决定骨折确定性手术时机的客观指标.%Objective To discuss the operative Lime for palienls with severe multiple fractures by observing indexes including C reaclive prolein( CPR) , creatine kinase( CK) ,MB isoenzyme of creatine kinase( CKMB) , blood glucose( GLU) ,etc. . Methods Palienls wilh ISS ≥16 were included in our study, observing indexes involving blood pressure,respiratory rate, temperalure,PaO2. The concentrations of CPR, CK,CKMB,GLU,etc. In peripheral blood were delecled at post-injury day 1,3,7 and 14, respectively. Finally, operation was performed till their vital signs became stable and the indexes such as CPR, CK, CKMB, GLU became normal or approached to normal level after 1-2 days. Results Totally 29 palients were followed up,8 of whom were followed up by phone calls. The follow-up lime ranged from 9 to 24 monlhs. Damage control operalion controlled bleeding and contamination in the majority of palients,and achieved a good recovery posloperatively. All of 10 open fraclures and 13 closed fractures indicated no infection of incision following internal fixalion. Conclusion The vital signs and indexes such as SpO2 , CPR, CK,CKMB,GLU can be used as the objective indexes to determine the optemal lime for performing orthopedics operalion.