2022年医学专题—严重多发伤的救治策略1(1).pptVIP免费

损伤(snshāng)ǔ控制外科——DamageControlSurgery第一页，共五十九页。第二页，共五十九页。第三页，共五十九页。EveryyearacrossEnglandandWales,10,000peopledieafterinjury.Itistheleadingcauseofdeathamongchildrenandyoungadultsof44yearsandunder.第四页，共五十九页。Inaddition,therearemanythousandswhoareleftseverelydisabledforlife.Takingaglobalviewof'lifeyearslost'throughprematuredeathanddisability,injurywillbein2ndplacein2020.第五页，共五十九页。传统观念er:emergencyor:operation第六页，共五十九页。Stone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(jiézā)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。第七页，共五十九页。损伤(sǔnshāng)控制外科DamagecontrolSurgery，DCS第八页，共五十九页。第九页，共五十九页。什么(shénme)是DCS?第十页，共五十九页。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(fùsū)过程的一部分，而不是终结。第十一页，共五十九页。传统观念er:emergencyor:operation第十二页，共五十九页。损伤(sǔnshāng)控制er:emergencyor:operationICU:intensivecareunit第十三页，共五十九页。Pape-1993CriticallyillpatientswithpulmonarycontusionsandfemurfracturesdidbetterwithdelayedtreatmentJTrauma34(1993)540第十四页，共五十九页。RetrospectivestudyofNTDB3069pts:femurfxsandISS>15Determine12hrswasthecutpointDelaybeyond12hrs=50%reductioninmortalityPtswithseriousabdominaltraumabenefitmostLikelyrelatedtopatientsresuscitationSupportsdelayedfixation…“DamageControl”DelayedFemurFixationReducesMortalityintheMIPMorshed,JBJS，2009第十五页，共五十九页。ExanguinatingpenetratingabdominalinjuryCurrentStudy（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？Colonicinjury7colonicana...