Wilson C B
Calif Med. 1969 Nov;111(5):343-6.
When head and blunt abdominal injuries are combined, the head injury is often afforded too much attention and the abdominal injury too little, especially when the patient is unconscious. If mismanaged, the abdominal injury is often the more serious threat to life. Except for extradural hemorrhage, neurosurgical intervention, when indicated, can be delayed until the patient has been thoroughly evaluated for the presence of extra cranial injuries with higher therapeutic priority. Abdominal examination of the unconscious or uncooperative patient is difficult. Tenderness as a sign of abdominal injury cannot be elicited. Abdominal rigidity (in the absence of rigid extremities), a silent abdomen, shock, and extreme restlessness may indicate intra-abdominal changes. Abdominal paracentesis is a valuable diagnostic aid, and the finding of blood, bile-stained fluid, intestinal contents or air is an indication for immediate laparotomy. Once all injuries are known, priorities for treatment can be assigned. Often head and abdominal injuries can be treated concomitantly.
当头部损伤与腹部钝性损伤同时存在时，头部损伤往往受到过多关注，而腹部损伤则关注不足，尤其是当患者昏迷时。如果处理不当，腹部损伤往往对生命构成更严重的威胁。除硬膜外出血外，如有指征，神经外科干预可推迟到患者已被全面评估是否存在具有更高治疗优先级的颅外损伤之后。对昏迷或不配合的患者进行腹部检查很困难。无法引出作为腹部损伤体征的压痛。腹部强直（无四肢强直）、腹部无肠鸣音、休克和极度烦躁不安可能提示腹内病变。腹腔穿刺术是一种有价值的诊断辅助手段，抽出的血液、胆汁样液体、肠内容物或气体表明需要立即进行剖腹手术。一旦了解了所有损伤情况，就可以确定治疗的优先顺序。通常头部和腹部损伤可以同时进行治疗。
