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[以损伤控制作为胸腹联合伤伴失血性休克主要手术方式的经验]

[Experience of damage control as the primary surgery for thoraco-abdominal injury with hemorrhagic shock].

作者信息

Moriwaki Yoshihiro, Kato Makoto, Toyoda Hiroshi, Kosuge Takayuki, Harunari Nobuyuki, Iwashita Masayuki, Tahara Yoshio, Suzuki Noriyuki

机构信息

Critical Care and Emergency Medical Center, Yokohama City University Medical Center, Yokohama, Japan.

出版信息

Kyobu Geka. 2010 Feb;63(2):112-5.

Abstract

We experienced a traumatic victim with thoracic and abdominal injury with hemorrhagic shock, who was successfully treated with damage control. Thoracic drainage revealed more than 300 ml/hour of continuous hemorrhage in the left thoracic cavity with 60-80 mmHg of non-responding hypotention. Although we performed emergency partial resection of the injured lung, intraabdominal packing and transcatheter arterial embolization, intrathoracic hemorrhage and hemorrhagic shock was not controlled. We decided re-thoracotomy and performed peri-pulmonary packing around the injured lung, by which we successfully controlled temporary intrathoracic hemorrhage and definitive left lower lobectomy. Peri-pulmonary packing was effective for intrathoracic hemostasis without lethal ventilatory and circulatory complication in this case.

摘要

我们遇到一名胸部和腹部受伤并伴有失血性休克的创伤患者,通过损伤控制策略成功治愈。胸腔引流显示左胸腔持续出血超过300毫升/小时,同时伴有60 - 80毫米汞柱的顽固性低血压。尽管我们进行了紧急部分肺叶切除术、腹腔填塞和经导管动脉栓塞术,但胸腔内出血和失血性休克仍未得到控制。我们决定再次开胸,在受伤肺周围进行肺周填塞,从而成功控制了暂时性胸腔内出血,并最终进行了左下肺叶切除术。在该病例中,肺周填塞对胸腔内止血有效,且未出现致命的通气和循环并发症。

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