严重多发伤的救治策略1.pptVIP免费

损伤控制外科——DamageControlSurgeryEveryyearacrossEnglandandWales,10,000peopledieafterinjury.Itistheleadingcauseofdeathamongchildrenandyoungadultsof44yearsandunder.--------TraumaAudit&ResearchNetwork:www.tarn.ac.ukInaddition,therearemanythousandswhoareleftseverelydisabledforlife.Takingaglobalviewof'lifeyearslost'throughprematuredeathanddisability,injurywillbein2ndplacein2020.TraumaAudit&ResearchNetwork:www.tarn.ac.uk传统观念er:emergencyor:operationStone等(1983年)31例有严重出血潜质的创伤患者。14例常规血液置换、详尽手术、关闭腹腔并行引流者仅存活1例。17例只行重要血管修复、简单结扎切除肠管盲端、盐水纱巾腹腔填塞、尽可能快结束剖腹者存活11例。损伤控制外科DamagecontrolSurgery，DCS什么是DCS?DCS指在救治严重创伤病人时,采用分期治疗方式,最大限度地减少内环境紊乱对病人的损害,降低死亡率。与传统一期手术创伤救治相比，DCS是复苏过程的一部分，而不是终结。传统观念er:emergencyor:operation损伤控制er:emergencyor:operationICU:intensivecareunitPape-1993CriticallyillpatientswithpulmonarycontusionsandfemurfracturesdidbetterwithdelayedtreatmentJTrauma34(1993)540RetrospectivestudyofNTDB3069pts:femurfxsandISS>15Determine12hrswasthecutpointDelaybeyond12hrs=50%reductioninmortalityPtswithseriousabdominaltraumabenefitmostLikelyrelatedtopatientsresuscitationSupportsdelayedfixation…“DamageControl”DelayedFemurFixationReducesMortalityintheMIPMorshed,JBJS，2009ExanguinatingpenetratingabdominalinjuryCurrentStudy（n=21）HistoricalStudy(n=24)period1997~20001988~1991ISS30.4±15.324.2±7.7TOR34.9±1.432.9±1.4PRBCsatDCⅠ11.2±8.322.7±11.6ICUPT-onarrival15.2±1.519.6±9.2ICUPTT-onarrival36.8±10.070.4±39.5Angiography4casesNoAbdominalcoverageVacuumpacdressingClosureskinorfasciaACS07？Colonicinjury7colonicanastomoses,2primaryrepairs/107colostomies,nocolonicanastomosesandrepairs/7septiccomplications32%29%Survivalrate90%(19/21)58%(14/24)同传统观念相比，DCS理论可更好的在“新的黄金1小时”中为患者存活提供机会新的黄金1小时指创伤后至患者出现生理极限即体温不升、酸中毒、凝血功能障碍...