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损害控制性复苏在187例血流动力学不稳定骨盆骨折患者中的应用

ISSN号：1673-6966
期刊名称：《中国急救复苏与灾害医学杂志》
时间：0
分类：R605.974[医药卫生—急诊医学;医药卫生—临床医学;医药卫生—外科学]
作者机构：[1]浙江省余姚市人民医院创伤外科,浙江315400
相关基金：卫生部卫生公益性行业科研专项基金资助项目（201002014）;浙江省医药卫生科技项目（2013KYAl91）

作者：金平[1], 李子龙[1], 张智达[1], 刘川[1], 张德峰[1], 朱建艇[1]

关键词：损伤控制复苏, 骨盆损伤, 休克, 凝血功能障碍, Damage control resuscitation, Pelvic trauma, Shock, Coagulopathy

中文摘要：

目的探讨损害控制性复苏在不稳定骨盆骨折患者应用中的价值。方法回顾性总结浙江省余姚市人民医院2009年1月～2014年1月期间通过损害控制复苏理念治疗的187例血流动力学不稳定骨盆骨折患者。目标血压为MAP65～70mmHg（合并严重颅脑损伤者除外），早期输注血液制品，限制晶体输入，浓缩红细胞、新鲜血浆和晶体比例控制在1：1：1；急诊行损伤控制性髂内动脉栓塞和腹膜后填塞止血。结果本组死亡率4．27％；复苏过程中浓缩红细胞、新鲜冰冻血浆2～6U，平均3．5U，晶体750-1500ml，平均900ml，比例为1：1：1；167例（89．3％）患者行髂内动脉造影和栓塞术，栓塞成功率（95．8％），栓塞操作时间35～61min，平均40．3min，无栓塞后中转剖腹或填塞手术病例；20例（10．7％）患者行剖腹探查术，其中11例（5．9％）因骨盆及腹膜后出血采纳骨盆及腹膜后填塞术；47例患者栓塞或剖腹探查术后行骨盆外固定。结论损伤控制复苏理念应该贯彻在血流动力学不稳定骨盆骨折患者诊疗的全过程，合理使用能够显著降低患者的死亡率。

英文摘要：

Objective To evaluated the application of damage control resuscitation in patients with hemodynamics unstable pelvic fractures . Methods A retrospective analysis was performed on a total of 187 patients with hemodynamics unstable pelvic fractures admitted in between January 2009 and January 2014. The damage control resuscitation were introduced through the concept of permissive hypotension, hemostasis resuscitation and damage control surgery. Results The mortality rate was 4.27%. The amount of fresh frozen plasma, red blood cells, and crystal reflected 3.5 u, 3.5u and 900 ml in average with a ratio of three fluids by 1：1： 1. 167 （89.3%） patients were performed with iliac artery angiography and emobilization with embolism success rate of 95.8%; the embolism operation time was between 35 and 61 minutes on an average 40.3 minutes. No embolism case was found developing to retroperitoneal pelvic packing. 20 （10.7%） of laparotomy were performed, 11 （5.9%） was adopted retroperitoneal pelvic packing for pelvic retroperitoneal bleeding. 47 received pelvic external fixation after embolization or laparotomy. Conclusion The damage control resuscitation concept is recommended to apply through the whole process for hemodynamics unstable pelvic fractures patients as it is considered being effective in reducing the mortality.

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