目的探讨严重多发脏器损伤的临床特点和诊治方法. 方法对 1988～1998年间收治的合并有闭合性腹内脏器损伤的严重多发伤、ISS大于16的165例患者进行回顾性分析. 结果 3个或 3个以上部位多发伤占28.5%.63例有腹内多脏器损伤.腹腔穿刺是确诊的主要检查手段,部分病例选用了腹部 B超和CT, 3项诊断检查阳性率均在 90%以上.全组漏诊腹内伤21例(12.7%),死亡29例(17.6%).死亡病例平均 ISS 41.6,明显高于非死亡病例 24.8(t=15.21, P<0.01). 结论严重多发伤病例应常规行诊断性腹腔穿刺,酌情选择腹部 B超和CT等检查,以排除腹内脏器损伤.对全身多发伤并存腹内伤的病例,要根据伤情确定急救处理顺序.剖腹手术中要注意多脏器损伤.ISS大于40提示预后不良.
Objective To investigate the clinical features and surgical management of patients with blunt multiple severe injuries. Methods 165 patients whth the injury severity score (ISS) over 16 were reviewed between 1988 and 1998. Results 47 cases (28.5%) had 3 or more injury sites, and 63 cases had multiple intraabdominal organ trauma. Abdominal trauma was evaluated by abdominocentesis in 143 cases, by US in 65 and CT in 47. All had positive values over 90%. Missed diagnosis of intraabdominal injury occurred in 21 cases (12 7%). The total mortality rate was 17 6% (29 cases). The average ISS for the died was 41 6 and 24 8 for the survivors ( t =15 21, P <0 01). Conclusion In patients with multiple severe trauma, abdominocentesis is a helpful screening method, US and CT are also among the routine diagnostic measures for intraabdominal injuries. During laparotomy, concomitant organ injuries should be detected with proper care. In patients with multiple severe trauma, ISS over 40 indicates a poor prognosis.
Chinese Journal of General Surgery