Nast-Kolb D, Waydhas C, Kastl S, Duswald K H, Schweiberer L
Chirurgische Klinik und Poliklinik, Ludwig-Maximilians-Universität München.
Chirurg. 1993 Jul;64(7):552-9.
Patients with multiple injuries were studied retrospectively (n = 483, ISS = 28 pts) and prospectively (n = 133, ISS = 42 pts) to determine the significance of concomitant intraabdominal lesions in the management and outcome of these subjects. In the retrospective part of the investigation 134 patients with intra-abdominal trauma presented with significantly more severe injuries (ISS = 38) as compared to 349 subjects with bland abdomen (ISS = 25). This resulted in a significantly different mortality rate (27 vs 11%). 119 patients with abdominal trauma were managed operatively, with surgery instituted within 4 hrs after the accident in 104 cases. Delayed abdominal surgery was performed in 18 patients due to complications from the initial laparotomy and in 15 cases because of delayed diagnosis. Delayed operations resulted in an increased rate of local complications (33 vs. 6%). In the prospective part of the study 33 out of 133 patients succumbed during resuscitation. In 14 of these, intractable bleeding from abdominal lesions was identified as the cause. In the 100 primary survivors, there was found no difference between 41 patients with and 59 patients without abdominal pathology with respect to injury severity, mortality, complications, initial hemodynamic parameters or the secondary release of inflammatory mediators. However, the initial requirement for red blood cell substitution was significantly higher in subjects with intra-abdominal trauma. Our results demonstrate that massive intra-abdominal hemorrhage may cause early mortality. In primary survivors, abdominal lesions have not shown to be of prognostic relevance, provided that early resuscitation, early diagnosis and early operative therapy can be instituted.
对多发伤患者进行了回顾性研究（n = 483，损伤严重度评分[ISS] = 28分）和前瞻性研究（n = 133，ISS = 42分），以确定合并腹内损伤在这些患者的治疗及预后中的意义。在调查的回顾性部分中，134例腹内创伤患者的损伤明显更严重（ISS = 38），而349例腹部无损伤患者的ISS为25分。这导致了显著不同的死亡率（27% 对11%）。119例腹部创伤患者接受了手术治疗，其中104例在事故发生后4小时内进行了手术。18例患者因初次剖腹术后的并发症而进行了延迟性腹部手术，15例是由于诊断延迟。延迟手术导致局部并发症发生率增加（33% 对6%）。在研究的前瞻性部分中，133例患者中有33例在复苏过程中死亡。其中14例被确定为腹部损伤导致的顽固性出血。在100例初次幸存者中，41例有腹部病变的患者与59例无腹部病变的患者在损伤严重程度、死亡率、并发症、初始血流动力学参数或炎症介质的二次释放方面没有差异。然而，腹内创伤患者对红细胞替代的初始需求明显更高。我们的结果表明，大量腹内出血可能导致早期死亡。在初次幸存者中，只要能进行早期复苏、早期诊断和早期手术治疗，腹部损伤并未显示出具有预后相关性。
