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目的 探讨多发伤行急诊一期手术处理的优越性及肺部并发症防治的主要措施。方法 通过创伤严重度综合评定计分法对 379例多发伤患者进行伤情回顾 ,分析急诊一期手术处理情况 ,分析呼吸机相关性肺炎 (VAP)的菌谱及药敏结果。结果 379例多发伤患者中 ,轻中度 36例 (12 93% ) ,重度 16 8例 (44 33% ) ,危重度 117例 (30 87% ) ,极危重度 45例(18 75 % )。机械通气治疗者平均使用时间为 7 19± 2 43d ,发生呼吸机相关性肺炎者菌谱分析示G- 菌占 5 4 72 % ,G+ 菌占 38 0 7% ,真菌占 7 2 1% ,其中混合感染占 2 8 86 %。全组死亡率17 15 % ,急诊一期手术治疗组死亡率 9 38%。结论 通过创伤严重度综合评定计分方法的应用 ,可以快速准确且简易地评估入院时患者的伤情 ;通过急诊一期手术的处理 ,可以有效地提高病人抢救的成功率 ;ARDS病人尽量缩短机械通气时间 ,VAP患者正确合理地应用抗菌药物 ,可以有效防治肺部并发症 ,以期降低死亡率。
Objective To investigate the superiority of primary surgical treatment of multiple traumatic injuries and the main measures of prevention and treatment of pulmonary complications. Methods A total of 379 cases of multiple traumatic injuries were retrospectively analyzed by comprehensive evaluation score of trauma severity. The surgical treatment of the first stage of emergency was analyzed, and the bacterial spectrum and drug susceptibility results of ventilator - associated pneumonia (VAP) were analyzed. Results Of the 379 cases with multiple trauma, 36 were moderate to severe (12.93%), 16.8 (44.33%) were severe, 117 (30.87%) were severe, and 45 (18 75%) were critically ill. The mean duration of use of mechanical ventilation was 7 19 ± 2 43 days. The prevalence of ventilator-associated pneumonia was 54.72% for G- bacteria, 38.07% for G + bacteria and 71.21% for fungi Mixed infections accounted for 2886%. The overall mortality rate was 17 15%. The mortality rate of the emergency surgery group was 9 38%. Conclusion The application of scoring method of trauma severity can quickly and accurately evaluate the patient’s injury at admission. The emergency treatment can effectively improve the success rate of patients’ salvage. ARDS patients should try their best to shorten the mechanical Ventilation time, VAP patients correct and reasonable use of antimicrobial agents, can effectively prevent and treat pulmonary complications in order to reduce mortality.