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Damage control surgery for patients with severe chest trauma complicated with limb and pelvic fractures |
JIANG Luquan1, YANG Le2, ZHENG Jian1, CHEN Jian1 |
1. Department of Thoracic Surgery 2. Department of Orthopeadics, Jiangsu Provincial Corps Hospital of Chinese; People's Armed Police Force, Yangzhou 225003,China |
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Abstract Objective To explore the applicability of damage control surgery for patients with severe chest trauma complicated with limb and pelvic fractures. Methods The clinical data on 98 patients with severe chest trauma complicated with limb fractures and pelvic fractures treated in our hospital between August 2014 and August 2019 was analyzed retrospectively. These patients were divided into the control group (46 cases) and the DCS treatment group (52 cases). Routine deterministic surgery was performed in the control group, while damage control surgery was performed in the DCS treatment group according to the injury control process within 10-14 days. After treatment, the duration of surgery, intraoperative bleeding volume, intraoperative blood transfusion volume, length of hospital stay, time spent in the ICU, days of mechanical ventilation, and rates of mortality and complications were compared between the two groups. Results The average length of hospital stay of the control group and the DCS treatment group was 26.91 d and 27.21 d respectively, compared with 13.12 d and 12.68 d in the ICU. There was no significant difference between the two groups. The duration of surgery of the two groups was (178.83±28.50 )min and (89.55±21.07 )min respectively, the days of mechanical ventilation were 7.12 d and 5.62 d respectively, the surgical bleeding volume was (692.68±42.59)ml and (268.52±39.67)ml respectively, and the intraoperative blood transfusion volume was(1024.20±30.10)ml and (610.85±40.24)ml respectively. There was statistically significant difference between the two groups (P<0.05).The complication rates of the control group and the DCS treatment group were 34.8% and 17.3% respectively, and the mortality rates were 23.9% and 7.7% respectively. There was significant difference between the two groups (P<0.05). Conclusions For patients with severe chest trauma combined with limb fractures and pelvic fractures, the use of damage control surgery can improve the survival rate of patients, which has good clinical value.
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Received: 20 October 2019
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[1] |
沈 洪,刘中民.急诊与灾难医学[M].2版.北京:人民卫生出版社,2019:259-261.
|
[2] |
Recknagel S,Bindl R,Kurz J,et al.C5aR-antagonist significantly reduces the deleterious effect of a blunt chest trauma onfracture healing[J].J Orthop Res,2012,30(4):581-586.
|
[3] |
Yuanbo Z,Jin W,Fei S,et al.ICU management based on PiCCO parameters reduces duration of mechanical ventilation and ICU length of stay in patients with severe thoracic trauma and acute respiratory distress syndrome [J].Ann Intensive Care,2016,6(1):113.
|
[4] |
王 敏,王红艳,傅占江.成分输血治疗创伤问题探讨[J].武警医学,2012,23(10):901-902.
|
[5] |
Mattu A.Damage control:advances in trauma resuscitation[J].Emerg Med Clin North Am,2018,36(1):15-16.
|
[6] |
Molnar T F. Thoracic damage control surgery[J]. J Thorac Dis,2019,11(Suppl 2):S158-S166.
|
[7] |
陈 建,郑 建,马仕昆.早期微创手术内固定治疗创伤性连枷胸36例[J].武警医学,2017,28(7):94-95.
|
[8] |
冯筑生,范颖楠,李俊杰,等.低压复苏治疗创伤失血性休克的系统评价[J].中华急诊医学杂志,2016,25(5):605-609.
|
[9] |
Garcia A, Martinez J,Rodriguez J,et al.Damage-control techniques in the management of severe lung trauma[J].J Trauma Acute Care Surg,2015 ,78(1):45-50.
|
[10] |
Palmer L. Fluid management in patients with trauma:restrictive versus liberal approach[J].Vet Clin North Am Small Anim Pract,2017,47(2):397-410.
|
[11] |
Drumheller B C,Stein D M,Scalea T M.Use of an intravascular temperature control catheter for rewarming of hypothermic trauma patients with ongoing hemorrhagic shock after combined damage control thoracotomy and laparotomy:a case series[J].Injury,2018 ,49(9):1668-1674.
|
[12] |
于 丽,段文杰,李春燕.早期肠内营养对严重胸部创伤患者预后的影响[J].中华创伤杂志,2015,31(3):228-229.
|
[13] |
张德刚,张 锴,王志刚,等.骨科损伤控制在严重多发伤合并股骨骨折治疗中的应用[J].中国矫形外科杂志,2017,25(3):119-122.
|
[14] |
王庚壮,潘昭宇,潘立峰.急诊多发伤患者死亡的影响因素分析[J].天津医药杂志,2017,8(45):885-888.
|
[15] |
蔺文祥,王志强,范熙明,等.损伤控制骨科理念在Gustilo-Ⅲ型胫腓骨骨折治疗中的应用[J].武警医学,2012,23(6):483-485.
|
[16] |
郎良军,陈勇杰,周云斌. 四肢骨折和骨盆骨折合并胸部损伤患者的骨科创伤控制与并发症情况研究[J]. 浙江创伤外科,2016,2l(4):294-295.
|
[17] |
Fan E, Sorbo L,Goligher E C,et al.Mechanical ventilation in adult patients with acute respiratory distress syndrome[J].Am J Respir Crit Care Med,2017,195(9):1253-1263.
|
[18] |
杨万广,杨宜昕,王万朋.损伤控制外科在严重腹部创伤合并骨折患者中的应用[J].河南大学学报(医学版),2018,37(2):128-130.
|
|
|
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