全身支持治疗在汶川地震多发伤高龄患者中的应用
|
摘要
背景:汶川地震中多发创伤的高龄患者除了伤情本身较重以外,还存在营养状态、全身情况差等问题,因此采取综合救治,尤其是全身支持治疗具有重要的意义。目的:探讨汶川地震中营养状况差的高龄多发伤患者的治疗对策。方法:2008年5月我科共收治26例营养状况差的高龄地震伤患者。男4例,女22例;年龄80～103岁,平均84.6岁。治疗前患者生命体征基本平稳,精神状态较差;血红蛋白(Hb)平均78.19g/L;红细胞压积(Hct)平均0.24;白蛋白(Alb)平均27.17g/L;K+平均3.37mmol/L,14例患者不同程度低钾。所有26例患者均行治疗前评估,补液、能量、电解质;22例患者接受输血治疗;8例患者输注人血白蛋白。治疗前后对患者生命体征,一般情况,精神状态,输血量,输注白蛋白量,Hb、Hct、Alb、K+值变化等进行观察和统计分析。结果:26例患者治疗前均接受了全面准确的评估,全身支持治疗及综合治疗。除2例因原发疾病较重转入ICU治疗外,其他生命体征平稳,一般情况及精神状态明显好转,营养状况显著改善,无麻醉及手术并发症,无严重术后并发症及死亡病例。治疗后Hb平均101.14g/L;Hct平均0.31;Alb平均33.62g/L。K+平均值3.91mmol/L,只有2例轻度低钾。结论:对高龄患者伤情与全身状态的准确评估,积极全身营养支持、综合治疗,对减少并发症、顺利度过围手术期、提高治愈率非常重要。
Background: In addition to the heavy injuries, the poor nutritional status and general condition are the main problems for the elderly patients with multiple trauma in the Wenchuan Earthquake. So it is very important to take a comprehensive treatment, especially the supportive therapy, to obtain the good clinical results. Objective: The aim of the study is to explore the therapeutic strategies of the elderly-malnutrition wounded patients from Wenchuan earthquake area. Methods: Totally 26 patients (4 males and 22 females; age of 80 to 103 years, mean 84.6 years) were treated in our hospital in May 2008. They had poor nutritional status because of earthquake injuries. Before treatment, patients had nearly stable vital signs and poor mental status with Hb of 78.19g/L, hematocrit (Hct) of 0.24, albumin (Alb) of 27.17 g/L, K+level of 3.37 mmol/L on avearage. Forteen patients had low K+level. All 26 patients were evaluated before treatment and received supporting treatment, among which 22 patients received blood transfusions, 8 patients infusion of human albumin. After treatment, all 26 patients' vital signs, mental status, blood transfusion volume, albumin infusion volume, Hb, Hct, Alb and K+levels were observed and statistically analyzed. Results: All the 26 patients accepted detailed examinations, supporting treatment and positive symptomatic treatment. Two patients were transferred into the ICU due to heavy primary disease, and the other 24 patients' vital signs, general condition and mental status improved obviously. Nutritional status of the patients significantly improved after treatment with Hb of 101.14 g/L, Hct of 0.31, Alb of 33.62 g/L and K+ of 3.91 mmol/L on average. There were only 2 patients with low K+ level. Conclusions: Assessment of traumatic condition and general condition, active nutritional support and positive symptomatic treatment are very important to improve the cure rate and reduce the rate of complication for the elderly-malnutrition wounded patients.
Background: In addition to the heavy injuries, the poor nutritional status and general condition are the main problems for the elderly patients with multiple trauma in the Wenchuan Earthquake. So it is very important to take a comprehensive treatment, especially the supportive therapy, to obtain the good clinical results. Objective: The aim of the study is to explore the therapeutic strategies of the elderly-malnutrition wounded patients from Wenchuan earthquake area. Methods: Totally 26 patients (4 males and 22 females; age of 80 to 103 years, mean 84.6 years) were treated in our hospital in May 2008. They had poor nutritional status because of earthquake injuries. Before treatment, patients had nearly stable vital signs and poor mental status with Hb of 78.19g/L, hematocrit (Hct) of 0.24, albumin (Alb) of 27.17 g/L, K+level of 3.37 mmol/L on avearage. Forteen patients had low K+level. All 26 patients were evaluated before treatment and received supporting treatment, among which 22 patients received blood transfusions, 8 patients infusion of human albumin. After treatment, all 26 patients' vital signs, mental status, blood transfusion volume, albumin infusion volume, Hb, Hct, Alb and K+levels were observed and statistically analyzed. Results: All the 26 patients accepted detailed examinations, supporting treatment and positive symptomatic treatment. Two patients were transferred into the ICU due to heavy primary disease, and the other 24 patients' vital signs, general condition and mental status improved obviously. Nutritional status of the patients significantly improved after treatment with Hb of 101.14 g/L, Hct of 0.31, Alb of 33.62 g/L and K+ of 3.91 mmol/L on average. There were only 2 patients with low K+ level. Conclusions: Assessment of traumatic condition and general condition, active nutritional support and positive symptomatic treatment are very important to improve the cure rate and reduce the rate of complication for the elderly-malnutrition wounded patients.
引文
[1]易敏,裴福兴,宋跃明,等.汶川地震骨科伤员伤情分析.中华外科杂志,2008,46(24):1853-1855.
[2]Giannoudis PV.Surgical priorities is damage control in poly-trauma.J Bone Joint Surg(Br),2003,85(4):478-483.
[3]曹烈虎,张春才,王志伟,等.地震后送老年伤员的伤情特点与治疗对策.中华骨科创伤杂志,2008,10(6):544-546.
[4]赵静文,吴冰.老年重型颅脑损伤患者30例早期肠内营养的疗效分析.中国老年学杂志,2012,31(5):1068-1069.
[5]尤佳,张明谏.老年创伤患者围手术期营养支持.天津医科大学学报,2004,10(3):480-481.
[6]Volkert D,Berner YN,Berry E,et al.ESPEN guidelines onenteral nutrition:Geriatrics.Clin Nutr,2006,25(2):330-360.
[7]付青格,张春才,王志伟,等.汶川地震老年伤员的治疗对策.中国骨伤,2008,21(10):735-736.
[8]徐薇.营养支持治疗对高龄老年肺炎患者的临床观察.中国医药指南.2011,9(30):145-146.
[9]曾文,宋明东,叶广宁.163例老年创伤的临床分析.岭南急诊医学杂志,2007,12(3):197-198.
[10]王一镗.老年创伤病人特点及致伤因素.实用老年医学,1999,13(5):227-229.
[11]韦军民.老年病人围手术期营养支持.中国实用外科杂志,2009,29(2):125-127.
[2]Giannoudis PV.Surgical priorities is damage control in poly-trauma.J Bone Joint Surg(Br),2003,85(4):478-483.
[3]曹烈虎,张春才,王志伟,等.地震后送老年伤员的伤情特点与治疗对策.中华骨科创伤杂志,2008,10(6):544-546.
[4]赵静文,吴冰.老年重型颅脑损伤患者30例早期肠内营养的疗效分析.中国老年学杂志,2012,31(5):1068-1069.
[5]尤佳,张明谏.老年创伤患者围手术期营养支持.天津医科大学学报,2004,10(3):480-481.
[6]Volkert D,Berner YN,Berry E,et al.ESPEN guidelines onenteral nutrition:Geriatrics.Clin Nutr,2006,25(2):330-360.
[7]付青格,张春才,王志伟,等.汶川地震老年伤员的治疗对策.中国骨伤,2008,21(10):735-736.
[8]徐薇.营养支持治疗对高龄老年肺炎患者的临床观察.中国医药指南.2011,9(30):145-146.
[9]曾文,宋明东,叶广宁.163例老年创伤的临床分析.岭南急诊医学杂志,2007,12(3):197-198.
[10]王一镗.老年创伤病人特点及致伤因素.实用老年医学,1999,13(5):227-229.
[11]韦军民.老年病人围手术期营养支持.中国实用外科杂志,2009,29(2):125-127.
版权所有：© 2023 中国地质图书馆 中国地质调查局地学文献中心