损伤控制性手术对创伤性肝破裂患者生存及相关应激指标的影响*

doi:10.3969/j.issn.1672-5069.2021.06.037

摘要/Abstract

摘要： 目的探讨采用损伤控制性手术(DCS)对创伤性肝破裂(TLR)患者生存及血清应激相关指标的影响。方法 2016年1月～2020年1月我院收治的TLR患者63例,按入院顺序排序被随机分为A组31例和B组32例。入院后均密切监测生命体征,开放2条或以上静脉通路。在A组,行一期常规手术治疗,给予B组患者DCS治疗。采用ELISA法检测血清皮质醇(COR)、C反应蛋白(CRP)、肾上腺素(EP)和白细胞介素-6(IL-6)水平。结果 A组抢救成功率为64.5%,显著低于B组的81.3%(P=0.032);B组手术时间、术中出血量、体温复常时间和乳酸清除时间分别为(135.4±25.7)min、(806.1±44.9)mL、(7.5±1.3)h和(12.3±5.1)h,显著短于或少于A组【分别为(182.1±28.6)min、(958.7±64.2)mL、(15.8±2.4)h和(24.8±8.6)h,P＜0.05】;在术后7 d,B组血清COR、CRP、EP和IL-6水平分别为(206.1±26.4)nmol/L、(21.2±2.7)mg/L、(225.7±21.0)ng/L和(51.5±6.0)μg/L,显著低于A组【分别为(228.4±28.9)nmol/L、(26.0±3.2)mg/L、(281.4±27.1)ng/L和(70.2±8.9)μg/L,P＜0.05】;B组凝血酶原时间、凝血酶时间和部分活化的凝血酶时间分别为(16.1±1.5)s、(15.1±0.7)s和(34.0±1.9)s,显著短于A组【分别为(20.4±1.7)s、(18.7±0.8)s和(39.5±2.4)s,P＜0.05】;术后,B组并发症发生率为6.3%,显著低于A组的22.6%(P＜0.05)。结论采用DCS二期手术治疗TLR患者能提高抢救成功率,减少并发症的发生,可能与降低了机体的应激反应、改善凝血功能有关。

关键词: 创伤性肝破裂, 损伤控制手术, 应激因子, 治疗

Abstract: Objective This study aimed to investigate the advantage of damage control surgery (DCS) in dealing with patients with traumatic liver rupture (TLR). Methods 63 patients with TLR were admitted to our hospital between January 2016 and January 2020, and were randomly divided into group A (n=31) and group B (n=32). The vital signs of patients in the two groups were closely monitored after admission and two or more venous pathways were established. The patients in group A were treated with one-stage conventional surgery, and those in group B were treated with DCS. Serum cortisol (COR), C-reactive protein (CRP), epinephrine (EP) and interleukin-6 (IL-6) levels were detected by ELISA. Results The rescue success rate in group A was 64.5%, significantly lower than 81.3%(P=0.032) in group B; the operation time, intraoperative blood loss, body temperature-returning time and lactic acid clearance time in group B were (135.4±25.7)min, (806.1±44.9)mL,(7.5±1.3)h and (12.3±5.1)h, significantly shorter or less than 【(182.1±28.6)min, (958.7±64.2)mL, (15.8±2.4)h and (24.8±8.6)h, respectively, P＜0.05】 in group A; at the end of seven days after operation, serum COR, CRP, EP and IL-6 levels were (206.1±26.4)nmol/L, (21.2±2.7)mg/L, (225.7±21.0)ng/L and (51.5±6.0)μg/L, significantly lower than【 (228.4±28.9)nmol/L, (26.0±3.2)mg/L, (281.4±27.1)ng/L and (70.2±8.9)μg/L, respectively, P＜0.05】 in group A; serum prothrombin time, thrombin time and activated partial thromboplastin time were (16.1±1.5)s, (15.1±0.7)s and (34.0±1.9)s, significantly shorter than 【(20.4±1.7)s, (18.7±0.8)s and (39.5±2.4)s, respectively, P＜0.05】 in group A; the incidence of postoperative complications was 6.3%, significantly lower than 22.6%(P＜0.05) in group A. Conclusion The application of DCS in patients with TLR could successfully improve survival with low incidence of complications, which might be related to the inhibition of reactive stress and the improvement of coagulation functions.

Key words: Traumatic liver rupture, Damage control surgery, Reactive stress, Therapy

俞士刚, 田佳, 吴铁, 樊书荣. 损伤控制性手术对创伤性肝破裂患者生存及相关应激指标的影响^*[J]. 实用肝脏病杂志, 2021, 24(6): 915-918.

Yu Shigang, Tian Jia, Wu Tie, et al. Damage control surgery in dealing with patients with traumatic liver rupture[J]. Journal of Practical Hepatology, 2021, 24(6): 915-918.

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损伤控制性手术对创伤性肝破裂患者生存及相关应激指标的影响^*

Damage control surgery in dealing with patients with traumatic liver rupture

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