CAJ | 학술논문

目的：总结腹部创伤救治经验。方法回顾性分析2005年6月至2012年5月该院收治的521例腹部创伤患者临床资料。结果521例腹部创伤患者损伤严重度（ISS）评分8～65分，平均23．6分。钝性伤453例，穿透伤68例。入院时休克231例（44．3％）。腹内损伤脏器777例次。腹部创伤手术率83．5％。合并多发伤331例。死亡34例（6．53％）中，平均 ISS 评分43．6分，死因为失血性休克13例：肝脏伤大出血 7例，腹内大血管伤4例，肺门血管伤2例；颅脑伤 7例；心脏 4例；胸腔严重感染致 ARDS 3例；术后腹腔间室综合征（ACS）1例；术后全身炎症反应综合征（SIRS）和多器官功能不全综合征（MODS）9例。存活者中与腹部创伤相关并发症发生率12．3％（60／487），主要为感染和出血。结论凡腹腔完整性被破坏均应手术探查；紧急情况下采用损伤控制原则（DCS）而不强求依据器官损伤分级决定手术方案；急诊室剖腹可提高腹内大血管伤救治成功率；重视“致死三联征”前兆，在其发生时应迅速终止手术。
목적：총결복부창상구치경험。방법회고성분석2005년6월지2012년5월해원수치적521례복부창상환자림상자료。결과521례복부창상환자손상엄중도（ISS）평분8～65분，평균23．6분。둔성상453례，천투상68례。입원시휴극231례（44．3％）。복내손상장기777례차。복부창상수술솔83．5％。합병다발상331례。사망34례（6．53％）중，평균 ISS 평분43．6분，사인위실혈성휴극13례：간장상대출혈 7례，복내대혈관상4례，폐문혈관상2례；로뇌상 7례；심장 4례；흉강엄중감염치 ARDS 3례；술후복강간실종합정（ACS）1례；술후전신염증반응종합정（SIRS）화다기관공능불전종합정（MODS）9례。존활자중여복부창상상관병발증발생솔12．3％（60／487），주요위감염화출혈。결론범복강완정성피파배균응수술탐사；긴급정황하채용손상공제원칙（DCS）이불강구의거기관손상분급결정수술방안；급진실부복가제고복내대혈관상구치성공솔；중시“치사삼련정”전조，재기발생시응신속종지수술。
Objective To investigate the experience of management of abdominal injuries.Methods The data of 521 cases with abdominal injury from June 2005 to May 2012 was analyzed retrospectively.Results In 521 cases,the grade of ISS within 8-65, average 23.6.453 suffered from blunt injuries and 68 from stab penetrating injuries.Hemorrhagic shock appeared in 231 patients (44.3%).The abdominal viscera injuries occurred in 777 cases.The operability of abdominal injuries was 83.5%,associated with polytrauma in 331.The mortality rate was 6.53%(34/521),in death group,the grade of ISS on average 43.6.13 cases died of hem-orrhagic shock,and 7 died of severe craniocerebral injury,4 died of cardiac injuries,3 died of ARDS due to flail chest and Severe pul-monary infection,one died of ACS and nine died of SIRS and MODS.The incidence rate of complication related to abdominal injury was 12.3% (60/487),most of them was infection and bleeding.Conclusion All that abdominal integrity be destroyed should be ex-plored;use of damage control surgery (DCS)and do not importune to decide to surgery on the basis of organ damage grading in e-mergency;perform laparotomy could improve the treatment success rate of abdominal large vessels injury in the emergency room;pay attention to the"lethal triad"precursor,and terminate the operation quickly when it happens.