CAJ | 학술논문

目的：探讨损伤控制性外科理论在合并腹部创伤的严重多发伤中的临床应用。方法回顾性分析2009年1月-2012年12月4年来本院就诊的合并腹部创伤的老年患者60例，所有患者根据预后分为死亡组（n ＝10）和存活组（n ＝50），入选患者按 ISS 评分分为3组：A 组（n ＝25）16～24分、B 组（n ＝23）25～34分、C 组（n ＝12）＞35分，观察死亡和存活患者的颅脑损伤例数、ISS 平均值和并发症例数，ISS 评分与损伤部位数、手术部位数、确定性手术时间、输血量、住院时间、并发症和死亡率的关系。结果死亡组和存活组患者出现颅脑损伤和并发症例数比较差异有统计学意义（P ＜0．05）；ISS 评分平均值分别比较差异也有统计学意义（P ＜0．01）。A、B 和 C 3组 ISS 评分相比差异有统计学意义（P ＜0．01）；3组确定性手术时间、输血量、住院时间随着 ISS 评分增加而明显增加，差异有统计学意义（P ＜0．01）；3组出现并发症和死亡例数比较差异有统计学意义（P ＜0．05）。结论 ISS 评分能对临床合并腹部损伤的多发伤患者的病情进行评估，并能指导治疗和评估预后，损伤控制性手术能明显降低老年创伤患者的术后并发症率和死亡率，改善患者预后。
목적：탐토손상공제성외과이론재합병복부창상적엄중다발상중적림상응용。방법회고성분석2009년1월-2012년12월4년래본원취진적합병복부창상적노년환자60례，소유환자근거예후분위사망조（n ＝10）화존활조（n ＝50），입선환자안 ISS 평분분위3조：A 조（n ＝25）16～24분、B 조（n ＝23）25～34분、C 조（n ＝12）＞35분，관찰사망화존활환자적로뇌손상례수、ISS 평균치화병발증례수，ISS 평분여손상부위수、수술부위수、학정성수술시간、수혈량、주원시간、병발증화사망솔적관계。결과사망조화존활조환자출현로뇌손상화병발증례수비교차이유통계학의의（P ＜0．05）；ISS 평분평균치분별비교차이야유통계학의의（P ＜0．01）。A、B 화 C 3조 ISS 평분상비차이유통계학의의（P ＜0．01）；3조학정성수술시간、수혈량、주원시간수착 ISS 평분증가이명현증가，차이유통계학의의（P ＜0．01）；3조출현병발증화사망례수비교차이유통계학의의（P ＜0．05）。결론 ISS 평분능대림상합병복부손상적다발상환자적병정진행평고，병능지도치료화평고예후，손상공제성수술능명현강저노년창상환자적술후병발증솔화사망솔，개선환자예후。
Objective To explore role of damage control surgery in the treatment of patients with abdominal trauma and severe multiple injuries.Methods 60 elderly patients with abdominal trauma were collected and divided into death group (n =10)and survival group (n =50)according to the prognosis.According to the ISS score,patients were divided into group A (n =25,16 to 24 points),group B (n =23,25 to 34 points)and group C (n =12,>35 points).Death and survival cases in patients with craniocerebral injury,mean ISS value and complications,ISS score and the number of injury,surgical site number,deterministic operation time,blood transfusion amount, length of hospital stay,the relationship between complications and mortality were observed in both groups.Results There were significant differences of craniocerebral injury and complications in death and survival group (P <0.05).There were significant differences of ISS score in group A, group B and group C (P <0.01).Operation time,blood transfusion amount,length of hospital stay increased with the increasing of ISS score (P <0.01).There were significant differences of complications and death cases in group A,group B and group C (P <0.05).Conclusion ISS score can guide therapy and evaluate prognosis,and damage control surgery can significantly reduce the postoperative incidence rate of complications and mortality in elderly patients with trauma.