[1]肖虹,黄警锐,胡唏,等.损伤控制性手术在178例以重型颅脑损伤为主的多发伤中的应用[J].陆军军医大学学报(原第三军医大学学报),2012,34(19):2012-2015.
 Xiao Hong,Huang Jingrui,Hu Xi,et al.Application of damage control surgery in treatment of 178 patients with multiple injury mainly manifested as severe craniocerebral injury[J].J Amry Med Univ (J Third Mil Med Univ),2012,34(19):2012-2015.
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陆军军医大学学报(原第三军医大学学报)[ISSN:1000-5404/CN:51-1095/R]

卷:
34卷
期数:
2012年第19期
页码:
2012-2015
栏目:
论著
出版日期:
2012-10-15

文章信息/Info

Title:
Application of damage control surgery in treatment of 178 patients with multiple injury mainly manifested as severe craniocerebral injury
作者:
肖虹黄警锐胡唏许毅刘科冯华
重庆市急救医疗中心神经外科;第三军医大学西南医院神经外科
Author(s):
Xiao  Hong Huang JingruiHu Xi Xu Yi Liu Ke Feng Hua
Department of Neurosurgery, Chongqing Emergency Medical Center, Chongqing, 400014; Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
关键词:
损伤控制重型颅脑损伤多发伤手术策略
Keywords:
damage control severe craniocerebral injury multiple injury surgery
分类号:
R181.32; R605; R651.15
文献标志码:
A
摘要:
目的      探讨应用损伤控制性手术(damage control surgery,DCS)治疗以重型颅脑损伤为主的多发伤的效果。      方法      2010-2011年我院178例重型颅脑损伤伴多脏器损伤患者(DCS组)在治疗中贯彻损伤控制外科原则救治,并与2009-2010年我院收治采用常规方法救治的156例重型颅脑损伤伴多脏器损伤患者(非DCS组)死亡率及预后进行比较。      结果      DCS组178例患者中136例行开颅血肿清除兼去骨瓣减压术,其他部位损伤分别行专科处理,存活109例(61.2%),死亡69例(38.8%),其中35例死于严重颅脑损伤,21例死于严重胸腹部损伤,13例死于MODS等严重并发症。DCS组和非DCS组患者围手术期死亡率[非DCS组为44.9%(70/156)]差异无统计学意义(P=0.988)。DCS组109例半年后随访GOS评分,恢复良好22例(20.2%),中残47例(43.1%),重残40例(36.7%)。DCS组和非DCS组存活患者恢复良好率[非DCS组为9.3%(8/86)]差异有统计学意义(P=0.037)。      结论      应用损伤控制外科原则处理以重型颅脑损伤为主的多发伤,合理选择和应用适当的措施,及时终止或减轻损伤导致的致命性脑损害,可提高救治成功率,值得临床重视及推广。
Abstract:
Objective      To study the curative effect of damage control surgery (DCS)on multiple injury mainly manifested as severe craniocerebral injury.       Methods      One hundred and seventy-eight patients with multiple injury accompanying severe craniocerebral injury underwent DCS in our hospital from 2010 to 2011. Their mortality and prognosis were compared with those of 156 patients with multiple injury accompanying severe craniocerebral injury who underwent conventional treatment (non-DCS treatment) in our hospital from 2009 to 2010.       Results      Of the 178  patients with multiple injury accompanying severe craniocerebral injury,136 (76.4%) underwent hematoma-removal craniotomy and bone flap-removal decompression.Injuries at other sites were treated in other departments. Of these 136 patients after treatment, 109 (61.2%) survived and 69 (38.8%) died (35 died of severe craniocerebral injury, 21 died of severe thoraco-abdominal injury, and 13 died of severe MODS complications).The perioperative morality was 38.8% (69/178) and 44.9% (70/156) in DCS treatment group and non-DCS treatment group, respectively (P=0.988).The 109 patients in DCS treatment group were followed up for 6 months and scored for GOS. The good recovery, moderate disability and severe disability were found in 22 (20.2%), 47 (43.1%) and 40 (36.7%) patients, respectively. The good recovery rate was significantly higher in DCS treatment group than in non-DCS treatment group (20.2% vs 9.3%, P=0.037).       Conclusion      DCS can increase the successful treatment rate for multiple injury accompanying severe craniocerebral injury when the measures are appropriately selected and applied in treatment of fatal cerebral injury, and is thus worth of spreading in clinical practice.

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更新日期/Last Update: 2012-09-27