中国急救医学
中國急救醫學
중국급구의학
CHINESE JOURNAL OF CRITICAL CARE MEDICINE
2014年
9期
847-850,851
,共5页
腹部创伤%输液量%腹膜%负压网片腹膜牵引
腹部創傷%輸液量%腹膜%負壓網片腹膜牽引
복부창상%수액량%복막%부압망편복막견인
Abdominal trauma%The infusion volume%Peritoneal%Mesh,vacuum andtraction closure technique
目的：观察负压网片腹膜牵引治疗腹部外伤腹膜关闭过程中的作用及体液量对治疗效果的影响。方法研究对象为2010-01～2014-01因腹部外伤腹膜暂时无法关闭而接受负压网片腹膜牵引治疗的患者。研究比较了经治疗后腹腔闭合和未闭合（即腹疝或腹膜部分闭合）患者的临床数据，比较输液量对腹腔闭合的影响。结果患者平均年龄（45．0±10．1）岁，治疗平均时间（31．0±6．8） d，腹膜闭合率60％。根据体质量计算得到体液负荷量平均值为7．2 kg （-8．0～21．6 kg），即治疗后平均体质量增加11．5％（-9．5％～27％）。液体导致体质量增加≥10％的患者腹膜闭合率比体质量增加＜10％的患者低（39％ vs 77％）。液体导致体质量增加≥20％的患者腹膜闭合率更低，提示随着液体在体内的积累，腹膜闭合率呈剂量依赖性降低。结论负压网片腹膜牵引方法可使腹部外伤患者获得较高的腹膜闭合率，但体液过量不利于腹膜的闭合。因此，病情严重患者进行静脉液体复苏时注意体液不应过量。
目的：觀察負壓網片腹膜牽引治療腹部外傷腹膜關閉過程中的作用及體液量對治療效果的影響。方法研究對象為2010-01～2014-01因腹部外傷腹膜暫時無法關閉而接受負壓網片腹膜牽引治療的患者。研究比較瞭經治療後腹腔閉閤和未閉閤（即腹疝或腹膜部分閉閤）患者的臨床數據，比較輸液量對腹腔閉閤的影響。結果患者平均年齡（45．0±10．1）歲，治療平均時間（31．0±6．8） d，腹膜閉閤率60％。根據體質量計算得到體液負荷量平均值為7．2 kg （-8．0～21．6 kg），即治療後平均體質量增加11．5％（-9．5％～27％）。液體導緻體質量增加≥10％的患者腹膜閉閤率比體質量增加＜10％的患者低（39％ vs 77％）。液體導緻體質量增加≥20％的患者腹膜閉閤率更低，提示隨著液體在體內的積纍，腹膜閉閤率呈劑量依賴性降低。結論負壓網片腹膜牽引方法可使腹部外傷患者穫得較高的腹膜閉閤率，但體液過量不利于腹膜的閉閤。因此，病情嚴重患者進行靜脈液體複囌時註意體液不應過量。
목적：관찰부압망편복막견인치료복부외상복막관폐과정중적작용급체액량대치료효과적영향。방법연구대상위2010-01～2014-01인복부외상복막잠시무법관폐이접수부압망편복막견인치료적환자。연구비교료경치료후복강폐합화미폐합（즉복산혹복막부분폐합）환자적림상수거，비교수액량대복강폐합적영향。결과환자평균년령（45．0±10．1）세，치료평균시간（31．0±6．8） d，복막폐합솔60％。근거체질량계산득도체액부하량평균치위7．2 kg （-8．0～21．6 kg），즉치료후평균체질량증가11．5％（-9．5％～27％）。액체도치체질량증가≥10％적환자복막폐합솔비체질량증가＜10％적환자저（39％ vs 77％）。액체도치체질량증가≥20％적환자복막폐합솔경저，제시수착액체재체내적적루，복막폐합솔정제량의뢰성강저。결론부압망편복막견인방법가사복부외상환자획득교고적복막폐합솔，단체액과량불리우복막적폐합。인차，병정엄중환자진행정맥액체복소시주의체액불응과량。
Objective To observe the therapeutic effects of the vacuum fascial traction and the role of body fluid volume for treatment on peritoneal closure process for traumatic abdominal trauma patients.Methods Research objects were temporarily unclosed abdominal trauma patients received vacuum fascial traction from 2010 January to 2014 January.The clinical data of abdominal closure and unclosed patients ( i.e., ventral hernia or peritoneal partially closed ) were observed .The influence of transfuse volume to abdominal close was detected .Results The average age of patients was (45.0 ± 10.1) years old, the average duration of treatment was (31.0 ±6.8) days.Peritoneal closure rate was 60%.Average fluid volume was 7.2 kg (range: -8.0~21.6 kg), namely average weight gained by 11.5%(range: -9.5%~27%) after treatment.Patients with weight gain≥10% had a lower facial closure rate than weight gain <10%(39%vs 77%).Facial closure rate seems to further decrease with weight gain 20%, suggesting a dose-response effect of progressive fluid accumulation .Conclusion The mesh, vacuum and traction closure technique can get higher peritoneal closure rate .But fluid overload is not conducive to the peritoneal closure .Therefore, for serious illness patients , overdose intravenous fluid resuscitation should be avoided .
