中华现代护理杂志
中華現代護理雜誌
중화현대호리잡지
CHINESE JOURNAL OF MODERN NURSING
2014年
3期
290-293
,共4页
肖霞%李永秀%万小娅%向生娟
肖霞%李永秀%萬小婭%嚮生娟
초하%리영수%만소아%향생연
损伤控制%肝脏损伤%凝血障碍%护理干预
損傷控製%肝髒損傷%凝血障礙%護理榦預
손상공제%간장손상%응혈장애%호리간예
Damage control%Liver trauma%Coagulopathy%Nursing intervention
目的：评估损伤控制外科（ DCS）技术在严重肝外伤患者治疗中的应用及护理。方法回顾性分析2008年1月-2012年12月83例采用DCS方法治疗及护理的Ⅳ、Ⅴ级严重肝外伤患者的基本资料。护理干预包括液体复苏、致死三联征和术后并发症防治。以同期非DCS治疗的Ⅳ、Ⅴ级的31例肝外伤患者作为对照组。结果 DCS组和对照组病死率分别为25．3％和51．6％，两组比较差异有统计学意义（χ2＝7．13，P＜0．01），患者主要死于创伤性凝血病。 DCS组和对照组患者腹腔间室综合征的发生率分别为6．0％，19．4％，膈下脓肿的发生率分别为7．2％，22．6％，两组比较差异均有统计学意义（χ2值分别为4．60，5．27；P＜0．05）。结论采用DCS治疗严重肝外伤合并致死三联征的患者可明显提高患者生存率。护理干预重点为术前限制性液体复苏；ICU阶段纠正凝血障碍、低体温和酸中毒；重视减少术后并发症的护理措施。
目的：評估損傷控製外科（ DCS）技術在嚴重肝外傷患者治療中的應用及護理。方法迴顧性分析2008年1月-2012年12月83例採用DCS方法治療及護理的Ⅳ、Ⅴ級嚴重肝外傷患者的基本資料。護理榦預包括液體複囌、緻死三聯徵和術後併髮癥防治。以同期非DCS治療的Ⅳ、Ⅴ級的31例肝外傷患者作為對照組。結果 DCS組和對照組病死率分彆為25．3％和51．6％，兩組比較差異有統計學意義（χ2＝7．13，P＜0．01），患者主要死于創傷性凝血病。 DCS組和對照組患者腹腔間室綜閤徵的髮生率分彆為6．0％，19．4％，膈下膿腫的髮生率分彆為7．2％，22．6％，兩組比較差異均有統計學意義（χ2值分彆為4．60，5．27；P＜0．05）。結論採用DCS治療嚴重肝外傷閤併緻死三聯徵的患者可明顯提高患者生存率。護理榦預重點為術前限製性液體複囌；ICU階段糾正凝血障礙、低體溫和痠中毒；重視減少術後併髮癥的護理措施。
목적：평고손상공제외과（ DCS）기술재엄중간외상환자치료중적응용급호리。방법회고성분석2008년1월-2012년12월83례채용DCS방법치료급호리적Ⅳ、Ⅴ급엄중간외상환자적기본자료。호리간예포괄액체복소、치사삼련정화술후병발증방치。이동기비DCS치료적Ⅳ、Ⅴ급적31례간외상환자작위대조조。결과 DCS조화대조조병사솔분별위25．3％화51．6％，량조비교차이유통계학의의（χ2＝7．13，P＜0．01），환자주요사우창상성응혈병。 DCS조화대조조환자복강간실종합정적발생솔분별위6．0％，19．4％，격하농종적발생솔분별위7．2％，22．6％，량조비교차이균유통계학의의（χ2치분별위4．60，5．27；P＜0．05）。결론채용DCS치료엄중간외상합병치사삼련정적환자가명현제고환자생존솔。호리간예중점위술전한제성액체복소；ICU계단규정응혈장애、저체온화산중독；중시감소술후병발증적호리조시。
Objective To investigate the clinical application and nursing effect of damage control surgery ( DCS ) in treating patients with severe liver trauma .Methods A retrospective study was used to investigate 83 patients with severe liver trauma ( grade Ⅳ, and Ⅴ) from January 2008 to December 2012 associated with the lethal triad of coagulopathy , hypothermia , and acidosis treated by DCS .Nursing intervention included fluid resuscitation , care of lethal triad and postoperative complications .And the control group was 31 patients with liver trauma of grade Ⅳand Ⅴwho had be treated without DCS .Results The mortality rate was 25.3%and 51.6% in the DCS group and the control group , and the difference was statistically significant (χ2 =7.13, P<0.01).The main cause of death was coagulopathy .The incidence of abdominal compartment syndrome was respectively 6.0% and 19.4% in the DCS group and the control group , the incidence of subdiaphragmatic abscess was 7.2%and 22.6%, and the differences were statistically significant (χ2 =4.60, 5.27, respectively;P<0.05).Conclusions DCS for patients with severe liver trauma can obviously increase their survival rate .The point of nursing intervention was limited fluid resuscitation before the surgery , correction of coagulopathy , hypothermia and acidosis during ICU as well as prevention and management of postoperative complications after the surgery .
