Scott Steven G, Belanger Heather G, Vanderploeg Rodney D, Massengale Jill, Scholten Joel
US Department of Veterans Affairs, James A. Haley Veterans' Hospital, Tampa, FL 33612-4745, USA.
J Am Osteopath Assoc. 2006 May;106(5):265-70.
Civilians and military personnel alike are increasingly being exposed to explosives in war zones and other regions of political conflict and, consequently, they are suffering associated blast-related polytrauma (multiple complex injuries). Although acute, emergency-based medical care for patients with blast-related trauma has been well described, postacute clinical management--which is of greatest interest to primary care physicians and rehabilitation specialists--has not been well discussed or researched. The authors offer a description of the common injuries seen in patients with blast-related polytrauma, as well as a conceptual model of a potential evaluation and treatment strategy in the postacute setting. Although medical evaluation of a patient typically proceeds in a sequential manner based on primary symptoms, the authors advocate a parallel approach to patient evaluation based on mechanism (cause) of injury. Such an approach relies on knowledge of the typical physical and psychological sequelae associated with a particular mechanism of injury to guide patient assessment and treatment. The authors highlight the mechanism-of-injury approach used with patients who have blast-related polytrauma at the Veterans Health Administration's (VHA) Veterans Affairs Medical Center in Tampa, Fla, site of one of the VHA's four Polytrauma Rehabilitation Centers.
平民和军事人员都越来越多地在战区和其他政治冲突地区接触到爆炸物，因此，他们正遭受与爆炸相关的多发伤（多种复杂损伤）。虽然针对爆炸相关创伤患者的急性、基于急诊的医疗护理已有详尽描述，但急性后期的临床管理——这是初级保健医生和康复专家最感兴趣的——却尚未得到充分讨论或研究。作者描述了爆炸相关多发伤患者常见的损伤情况，以及急性后期潜在评估和治疗策略的概念模型。虽然对患者的医学评估通常基于主要症状按顺序进行，但作者提倡基于损伤机制（原因）对患者进行并行评估的方法。这种方法依靠对与特定损伤机制相关的典型身体和心理后遗症的了解来指导患者评估和治疗。作者重点介绍了在佛罗里达州坦帕市退伍军人健康管理局（VHA）的退伍军人事务医疗中心对爆炸相关多发伤患者采用的损伤机制评估方法，该中心是VHA四个多创伤康复中心之一。
