地震伤员严重下肢挤压伤保肢治疗体会
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摘要
目的探讨地震伤员严重肢体挤压伤的保肢治疗。方法在不干扰批量伤员救治的前提下,通过严格掌握纳入指征,合理配置医疗人员,按照分级救治程序,对伤员进行紧急救治和早期处理,特别重视监护调整脏器功能,一旦出现无法控制的生命体征紊乱即行截肢,病情稳定后及时后送。结果1例肾功能损害加重再次手术截肢,9例均成功存活。至后送时,8例保肢伤员肢端血管搏动有力,毛细血管充盈时间正常,初期保肢成功率达88.9%。结论依托良好的人员配置、ICU监护下脏器功能调整和科学的分级救治程序,部分严重挤压伤患者可以避免截肢。
Objective To investigate the salvage method for patients with severe lower limb crush injury in earthquake.Methods According to grading rescue procedure,reasonably arraying staff,and control of the indication,first-aid and early management were carried out.Especially,monitoring and adjusting organ function.Once the vital sign occurred,attention was paid to uncontrollable disorder,and amputation was carried out immediately.Results Because renal function became more serious,1 case underwent amputation.Eight cases had satisfactory local blood supply,and the achievement ratio of initial stage limb salvage reached 88.9%.Conclusion Reasonable staff array,grading rescue procedure and establishing temporary ICU for monitoring and adjusting organ function could make part of patients with severe crush injury avoid amputation.
Objective To investigate the salvage method for patients with severe lower limb crush injury in earthquake.Methods According to grading rescue procedure,reasonably arraying staff,and control of the indication,first-aid and early management were carried out.Especially,monitoring and adjusting organ function.Once the vital sign occurred,attention was paid to uncontrollable disorder,and amputation was carried out immediately.Results Because renal function became more serious,1 case underwent amputation.Eight cases had satisfactory local blood supply,and the achievement ratio of initial stage limb salvage reached 88.9%.Conclusion Reasonable staff array,grading rescue procedure and establishing temporary ICU for monitoring and adjusting organ function could make part of patients with severe crush injury avoid amputation.
引文
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[2]杨惠玲,潘景轩,吴伟康.高级病理生理学[M].北京:科学技术出版社,1998.330-332.
[3]孔禄生,王庆林.创伤护理学[M].北京:人民军医出版社,1990.52,321.
[4]孙红振,王爱民,赵玉峰,等.超时限四肢主要血管损伤的救治[J].中华创伤杂志,2005,4(21):272-275.
[5]王立金,金丽娟,王静珍,等.挤压伤引起多器官衰竭的动物模型[J].中国病理生理杂志,1994,10(2):220-221.
[6]Bone RC,Balk RAA,Cerra FB,et al.American college ofchest physicians/society of critical care medicine consensusconference:definitions for the sepsis and organ failure andguidines for the use of innovative therapies in sepsis[J].Crit Care Med,1992,20(6):864-870.
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