Sagraves Scott G, Toschlog Eric A, Rotondo Michael F
Department of Surgery, East Carolina University, Brody School of Medicine, 600 Moye Blvd, Greenville, NC 27834, USA.
J Intensive Care Med. 2006 Jan-Feb;21(1):5-16. doi: 10.1177/0885066605282790.
"Damage control" surgery has evolved during the past 20 years from an accepted surgical technique in the traumatized, moribund patient to an expanded role in critically ill, nontraumatized patients. Physicians caring for these patients in extremis have begun to recognize a pattern of severe physiologic derangement that prompts an abbreviated laparotomy after hemorrhage and contamination control. Emphasis then shifts from the operating theater to the intensive care unit, where the patient's physiologic deficits are corrected. Once these derangements have been resolved, the patient is taken back to the operating room for definitive, reconstructive surgical care. The purpose of this article is to review the concept of "damage control" in reference to the patient whose pathophysiologic depletion prompts the need for it. Resuscitation in the intensive care unit will be summarized, pitfalls will be identified, and treatment plans will be delineated. Complications such as abdominal compartment syndrome and difficult abdominal wall closures will also be discussed.
“损伤控制”手术在过去20年里已从创伤濒死患者所采用的一种公认手术技术，发展到在危重症非创伤患者中发挥更广泛的作用。照顾这些处于危急状态患者的医生已开始认识到一种严重生理紊乱模式，这种模式促使在控制出血和污染后进行简化剖腹术。然后重点从手术室转移到重症监护病房，在那里纠正患者的生理缺陷。一旦这些紊乱得到解决，患者会被送回手术室接受确定性的重建手术治疗。本文旨在回顾针对因病理生理耗竭而需要“损伤控制”的患者的这一概念。将总结重症监护病房的复苏情况，识别陷阱，并勾勒治疗计划。还将讨论诸如腹腔间隔室综合征和腹壁关闭困难等并发症。
