Waydhas C, Seekamp A, Sturm J A
Klinik für Unfallchirurgie, Universitätsklinikum Essen, Hufelandstrasse 55, 45147 Essen.
Chirurg. 2006 Aug;77(8):682-6. doi: 10.1007/s00104-006-1219-y.
Severe injuries in patients of all ages and injuries in elderly multi-morbid subjects are a relevant medical and economic challenge. Optimal care of the polytraumatized patient can be best delivered by physicians specializing both in causal treatment of the injury or underlying disease and in intensive care. For care of critically ill injured patients, trauma surgeons with a certified specialty in intensive care medicine appear best suited. Of course, directing a surgical or trauma intensive care unit has to be full-time. Specialization of trauma surgeons (e.g., in the USA) has resulted in a considerable improvement in outcomes at least partly related to specialized trauma intensive care. Further improvement of trauma care relies on competent and innovative research not only in the fields of general intensive care, e.g., ventilation, but particularly in the complex aspects of the causality of the traumatic disease. An integrative view of the pathobiochemical, pathophysiological, and immunopathological sequelae of severe trauma under consideration of the various surgical and therapeutic strategies is the actual focus of research in surgical critical care medicine. Organ dysfunctions have to be modulated as they develop. Surgeons and trauma surgeons lead worldwide in this field of research. Obviously, competent research in polytrauma care requires competence in polytrauma intensive care.
各个年龄段患者的重伤以及老年多病患者的损伤都是重大的医学和经济挑战。对于多发伤患者的最佳治疗，最好由既擅长损伤或基础疾病的病因治疗又擅长重症监护的医生来提供。对于危重伤员的护理，具有重症医学专业认证的创伤外科医生似乎最为合适。当然，管理外科或创伤重症监护病房必须是全职工作。创伤外科医生的专业化（例如在美国）至少部分地导致了治疗结果的显著改善，这与专门的创伤重症监护有关。创伤护理的进一步改善不仅依赖于普通重症监护领域（如通气）的有能力和创新性的研究，而且尤其依赖于创伤性疾病病因复杂方面的研究。考虑到各种手术和治疗策略，对严重创伤的病理生化、病理生理和免疫病理后遗症的综合观点是外科重症医学研究的实际重点。器官功能障碍一旦出现就必须加以调节。外科医生和创伤外科医生在这一研究领域处于世界领先地位。显然，多发伤护理方面的有能力的研究需要多发伤重症监护方面的能力。
