颅脑颈胸腹骨盆会阴钢筋复杂贯通伤患者的多学科协作救治及护理
摘要
目的:总结颅脑颈胸腹骨盆会阴钢筋复杂贯通伤患者的成功治疗及护理方法,为多发伤救治提供经验。方法:回顾性分析1例高处坠落伤致钢筋贯穿头颈胸腹骨盆会阴的复杂贯通伤患者的救治及护理过程。医院行政值班协调消防队及急诊外科、心外科、胸外科、泌尿外科、耳鼻喉科、麻醉科、手术室近30名专家参与手术,术前制定多套应急预案,建立完善的监护监测患者病情。手术经气管切开置入气管插管后在静吸复合全麻下进行,开颅、开胸、开腹显露钢筋,保护大血管及重要脏器,由会阴部完整抽出钢筋,止血修复创伤。结果:手术用时7 h,术中输注红细胞6 U,血浆600 ml。患者术后24 h苏醒,术后64 d康复出院。结论:多发贯通伤病情复杂,致死率高。多学科协作,建立一支专业高效的创伤急救队伍,制定创伤救治流程;术前完成必要的检查,掌握患者病情,制定多套应急预案;术中兼顾手术安全和减少二次损伤;手术室护士及时与相关科室医生沟通,对提高严重创伤抢救成功率至关重要。
引文
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[2]陈世雄,陈胜家,许家君.颈胸腹贯通伤1例[J].临床急诊杂志,2015,16(2):157-158.
[3] Obea WB,James DH,Charles MC,et al. Rockwood and Green'S fractures in adults[M]. 7th ed. Philadelphia:IAppincott Williams&Wilkins,2010:245-246.
[4] Grnen RL,Brohi K,Schreiber M,et al. Haemorrhage eontml inseverely injured patients[J]. Lancet,2012,380(9847):1099-1108.
[5] Romano L,Pinto A,Niola R,et al. Bleeding due to pelvic frac-tures in femalepatients:pictorial reviewof multidetector computedtomography imaging[J]. Current Problems in Diagnostic Radiology,2012,41(3):83-92.
[6] Nemsadze G,Lapiashvili E,Urnshadze O,et al. Role of multislicespiral computed tomographyin diagnosis of spinalinjuriesinpolytrauma patients[J]. Georgian Med News,2011,11(200):42-51.
[7] Zhang Q,Chen W,Uu H,et al. Theanterior dislocation of thesacroiliacjoint:a reportof four cases and review of the literatureand treatmentalgorism[J]. Arch Orthop Trauma Surg,2009,129(7):941-947.
[8]徐加红.急救护理流程在创伤性休克患者中的应用[J].中华现代护理杂志,2014,20(9):1082-1083.
[9]许开云,桂莉.分时段改良创伤评分法在多发伤患者中的应用[J].齐鲁护理杂志,2015,21(19):103-105.
[10]魏民,董伦,张恒柱,等.开放性颅脑损伤合并异物嵌插的诊断与治疗[J].临床神经外科杂志,2016,13(4):289-292.
[11]白祥军,裘法祖.建立创伤外科专科,提高多发伤救治水平[J].中华创伤杂志,2004,20(12):709-710.
[12] Berg RJ,Inaba K,Okoye O,et al. The peril of thoracoabdominal firearm trauma:984 civilian injuries reviewed[J]. J Trauma Acute Care Surg,2014,77(5):684-91.
[13]吴永红,周艳,王振磊.持续腹内压监测在ICU多发伤患者中的早期应用及护理[J].齐鲁护理杂志,2015,21(20):57-58.