摘要
目的:探讨损伤控制复苏技术(DCR)在血流动力学不稳定骨盆骨折中的应用及意义。方法:回顾性分析2019年3月至2023年3月救治的76例血流动力学不稳定骨盆骨折患者临床资料。76例患者入院后均予建立静脉通路、输血、控制性手术、补液扩容等治疗。根据复苏方式不同分别分为损伤控制复苏组(治疗组,40例)和传统正压复苏组(对照组,36例),比较治疗组和对照组24 h内胶体液、晶体液、红细胞、血浆和血小板的输注量,记录PT/APTT恢复时间、体温恢复时间、乳酸清除时间、患者死亡及DIC发生情况。结果:两组患者基本资料、致伤原因、休克程度、骨折类型等经检验差异均无统计学意义(P>0.05)。对照组输注的红细胞悬液、晶体液、胶体液明显多于治疗组,对照组输注的血浆、血小板少于治疗组,治疗组死亡率明显低于对照组,两组比较差异有统计学意义(P<0.05)。对照组DIC发病率明显高于治疗组,对照组凝血功能恢复时间、乳酸廓清时间和体温恢复时间较治疗组长,差异有统计学意义(P<0.05)。结论:对血流动力学不稳定骨盆骨折患者,在损伤早期及时采取损伤控制复苏(DCR)策略,可提高复苏效果和抢救成功率,DCR解决了严重骨盆骨折患者早期复苏的关键性问题,为患者后续进一步手术治疗创造了有力条件。
Objective:To explore the application and significance of Damage Control Recovery(DCR)technique in hemodynamically unstable pelvic fractures.Methods:A retrospective analysis was conducted on the clinical data of 76 patients with hemodynamically unstable pelvic fractures treated from March 2019 to March 2023.After admission,all 76 patients were treated with venous access,blood transfusion,controlled surgery,fluid replacement and volume expansion.According to different resuscitation methods,the patients were divided into injury control resuscitation group(treatment group,40 cases)and traditional positive pressure resuscitation group(control group,36 cases).The infusion volume of colloidal solution,crystal solution,red blood cells,plasma,and platelets within 24 hours between the treatment group and the control group was compared,and the recovery time of PT/APTT,temperature recovery time,lactate clearance time,patient death,and DIC occurrence were recorded.Results:There was no statistically significant difference(P>0.05)in the basic information,cause of injury,degree of shock,and type of fracture between the two groups of patients.The control group received significantly more red blood cell suspension,crystal fluid,and colloid fluid infusion than the treatment group,while the control group received less plasma and platelets infusion than the treatment group.The mortality rate of the treatment group was significantly lower than that of the control group,and the difference between the two groups was statistically significant(P<0.05).The incidence rate of DIC in the control group was significantly higher than that in the treatment group.The recovery time of coagulation function,lactate clearance and body temperature in the control group were significantly longer than those in the treatment group(P<0.05).Conclusion:For patients with hemodynamically unstable pelvic fractures,timely adoption of damage control resuscitation(DCR)strategy in the early stage of injury can improve the recovery effect and rescue success rate.DCR solves the key problem of early recovery in patients with severe pelvic fractures and creates strong conditions for further surgical treatment.
作者
刘文凯
郭立成
Liu Wen-kai;Guo Li-cheng(Provincial Clinical College of Medicine,Fujian Medical University,Fuzhou 350001,China;Department of Emergency Department,Fujian Provincial Hospital,Fuzhou 350001,China;Provincial Hospital Affiliated to Fuzhou University,Fuzhou 350001,China)
