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

Abstract

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

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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Damage control surgery in dealing with patients with traumatic liver rupture

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