创伤评分法在地震伤骨盆骨折并多发损伤中的运用及相应的伤害控制策略
摘要
目的:探讨创伤评分法在地震所致的骨盆骨折合并多发损伤中的运用及相应的伤害控制策略。方法:对91例骨盆骨折合并多发性损伤的地震伤员进行回顾性分析,分别采用院前的CRAMS评分法及院内的NISS(The New Injury Severity Score)评分法进行伤情严重程度评估,从而探索其伤害控制治疗策略。结果:两种评分方法在本组病例中对伤情评估存在差异(P<0.05),在评估伤情的严重程度与合并的损伤部位的多少、骨折的分类、转归之间均无明显差异;而两种评分法各自评估的伤情严重程度与合并损伤部位的多少、与骨折分类也无明显差异,但其严重程度与转归均存在差异性;在伤害控制方面,临时固定与全身综合治疗及紧急复苏治疗相比有明显差异。结论:CRAMS评分对骨盆骨折并多发损伤的地震伤员的院前的分拣伤员有指导意义,NISS评分法可作为院内的伤情分级评判标准,以创伤评分为依据的伤害控制策略体现出了骨盆骨折合并多发伤伤员的救治原则。
引文
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Demetriades D,Karaiskakis M,Toutouzas K,et al.Pelvicfractures:epidemiology and predictors of associated abdominalinjuries and outcomes[J].J Am Coll Surg,2002,195(1):1-10.
Gormican S P.CRAMS scale:field triage of trauma victims[J].AnnEmerg Med,1982,11(1):132-135.
Copes W S,Champion H R,Sacco W J,et al.The injuries severityscore revisited[J].J Trauma,1988,28(1):6.
Gray A,Goyder E C,Goodacre S W,et al.Trauma triage:acomparison of CRAMS and RTS in a UK population[J].Injury,1997,28(2):97-101.
Baker S P,O'Neill B,Haddon W Jr,et al.The injury severityscore:a method for describing patients with multiple injuries andevaluating emergency care[J].J Trauma,1974,14(2):187-196.
Copes W S,Champion H R,Sacco W J,et al.The injury severityscore resvisited[J].J Trauma,1998,28(1):69-72.
Osler T,Baker S P,Susan P,et al.A modification of the injuryseverity score that both improves accuracy and scoring[J].JTrauma,1997,43(5):922-925.
Osler T M,Rogers F B,Badger G J,et al.A simple mathematicalmodification of TRISS markedly improves calibration[J].J Trauma,2002,53(4):630-634.
Rittmeister M,Lindsey R W,Kohl H W3rd.Pelvic fracture amongpolytrauma decedents.Trauma-based mortality with pelvic fracture acase series of74patients[J].Arch OrthopTrauma Surg,2001,121(1):43-49.
Ertel W,Eid K,Keel M,et al.Therapeutical strategies andoutcome of poly-traumatized patients with pelvic injuries:a six-yearexperi-ence[J].Euro J Trauma,2000,26(2):278-286.
SCalea T M,Bswell S A,Scott J D,et al.External fixation as abridge to intramedullary nailing for patients with mlultipleinjuriesandwith femur fraetures:damage control orthopedies[J].J Trauma,2000,48(4):613.
Pape H C,Giannoudis P,Krertek C.The timing of fracture trearmentinpolytrauma Patients:relevance of damage control orthopedicssurgery[J].Am J Surg,2002,183(4):622.
Demetriades D,Karaiskakis M,Toutouzas K,et al.Pelvicfractures:epidemiology and predictors of associated abdominalinjuries and outcomes[J].J Am Coll Surg,2002,195(1):1-10.
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