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目的探讨损伤控制外科(damage control surgery,DCS)策略在严重烧创复合伤救治中的应用效果。方法 2004年1月-2009年12月,对28例严重烧创复合伤患者按照DCS策略进行抢救治疗。男18例,女10例;年龄8～56岁,中位年龄39.5岁。烧伤面积为(15%～56%)总体表面积,损伤严重度(ISS)评分为25～56分,创伤指数为17～24分。均出现DCS致死三联征。烧伤合并2个解剖部位损伤12例,3个6例,4个及以上10例。现场急救后收治住院16例,外院转入12例;受伤至入院时间20min～36h。给予液体复苏、急诊手术控制出血、清除严重污染、生物敷料暂时覆盖创面,生命体征稳定后行系统手术治疗。结果术后死亡2例,其中1例死于多器官衰竭,1例死于严重脑外伤合并重度休克;余26例患者中23例创面Ⅰ期愈合出院,3例残余少许创面出院;住院时间31～398d,平均62d。结论应用DCS策略可提高严重烧创复合伤患者抢救成功率。
Objective To explore the effect of DCS (Damage Control Surgery) in the treatment of severe combined burn wounds. Methods From January 2004 to December 2009, 28 patients with severe burn-wound combined injuries were treated according to DCS strategy. 18 males and 10 females; aged 8 to 56 years old, the median age of 39.5 years old. Burns area (15% to 56%) of the total surface area, the severity of injury (ISS) score of 25 to 56 points, trauma index of 17 to 24 points. DCS appear dead triple symptoms. Burns combined with two anatomical lesions in 12 cases, 3 6 cases, 4 and above 10 cases. After the scene first aid, 16 cases were admitted to the hospital and 12 cases were transferred to the hospital; Injured to admission time 20min ~ 36h. Give liquid resuscitation, emergency surgery to control bleeding, remove serious pollution, biological dressings temporarily cover the wound, vital signs and stability of the system after surgical treatment. Results Two patients died after operation, one died of multiple organ failure and one died of severe traumatic brain injury with severe shock. Twenty-three of the 26 patients were discharged from the wounds in the first phase and discharged from the remaining 3 with minimal residual wounds. The length of hospital stay was 31 ~ 398d, an average of 62d. Conclusion The application of DCS strategy can improve the success rate of salvage in patients with severe burn wounds.