[摘要] 目的 探讨腹部损伤为主的严重多发伤的诊断及救治措施。方法 对1999年9月～2006年3月救治的194例以腹部损伤为主的严重多发伤患者的资料进行分析总结。结果 本组病例均符合多发伤诊断标准，创伤严重度评分(ISS)≥16。急诊腹部手术162例/次，其中41例在一次麻醉下分组同台完成了两个以上部位的手术。重症监护病房(ICU)平均住院日25.8天。临床治愈122例(62.9%)，残疾37例(19.1%)，死亡35例(18.0%)。结论 采集病史，查体常需和止血、抗休克、维持呼吸道通畅等抢救措施同时进行。诊断性腹腔穿刺和B超检查是快速、简洁、敏感的诊断方法，而CT诊断的准确率高。诊断过程中应尽量减少漏诊。手术顺序应按受损器官的重要性和损伤的严重程度决定。主动实施创伤控制性手术(DCO)策略，可有效降低死亡率。严重多发伤病人术后均应进入ICU监护和治疗。

    [关键词] 腹部损伤；多发伤；急救；手术

    Management of 194 patients with abdominal injuries in severe multiple trauma

    HAN Qing,CHEN Bao-dong,WU Shao-hao,et al.Department of Trauma,the 2nd Hospital of Shenzhen,Shenzhen 518029,China

    [Abstract] Objective To discuss clinical diagnosis and treatment of abdominal injury complicated with severe multiple trauma.Methods The clinical data of 194 cases of abdominal injuries in severe multiple trauma treated in our hospital from Sept.1999～Mar.2006 were analysed.Results A total of 194 patients sustaining severe multiple trauma,Injury Severity Score (ISS)≥16.162 patients underwent immediate abdominal operations.Among them 41 patients received two operations on different anatomic regions under a single anesthesia.Mean length of stay in the intensive care unit (ICU)was 25.8 days.122 cases had a good recovery,37 cases disabled and 35 cases were died.Conclusion Certain injuries are so critical that the history collection,the emergent physical examination and definitive resuscitation must be undertaken at the same time.Diagnostic peritoneocentesis and ultrasound are rapid and accurate modalities for the diagnosis of intraabdominal injury.CT is noninvasive,sensitive,and accurate for the evaluation of abdominal injury in hemodynamically stable patients,and missed diagnosis should be reduced as far as possible.The intraabdominal operation sequence should be depended on the importance and the injury severity of the involved organ.Damage control operation (DCO)should precede definitive reconstruction.All postoperative patients should enter the ICU for the intensive cure. ......