Ilić N, Petricevic A, Radonić V, Biocić M, Petricević M
Department of Surgery, Split University Hospital, Croatia.
Int Surg. 1997 Jul-Sep;82(3):316-8.
From April 1991 till December 1995, Split University Hospital played a major role as a third échelon war hospital during the war in Croatia and Bosnia and Herzegovina. Among 2856 treated battle casualties in general, 70 patients with penetrating thoraco-abdominal war injuries were treated at the Department of Surgery. Explosive wounds were present in 38 (54%), gunshot wounds in 32 (45%) and puncture wounds in four (5.70%) patients.
The medical data from the evacuation unit, transportation, emergency department, surgical management and follow-up were obtained and analyzed. The principle of treatment of such patients is described, with particular reference to thoracophrenolaparotomy as the most efficient diagnostic-therapeutic surgical approach.
There were considerably more explosive wounds than gunshot and puncture wounds (ratio 38/32/4). Resource utilization analysis showed a great amount of blood products (average 1.250 ml per patient), rehydrant solutions (average 3.750 ml per patient) and seven days antimicrobial chemoprophylaxis (penicillin, gentamycin, metronidazole) used. Mean time elapsed between injury and definitive surgical repair was seven hours (range, 1 to 48 hours). Recovery on discharge was recorded in 61 (80%) and lethal outcome in nine (13%) patients.
The treatment of respiratory insufficiency and hemorrhagic shock, and prevention of infection are the basis of the management of these injuries. Treatment success depends on emergency first-aid, quick transportation, early diagnosis, resuscitation, surgical therapy and intensive care.
1991年4月至1995年12月期间，斯普利特大学医院在克罗地亚和波斯尼亚和黑塞哥维那战争期间作为三级梯队战地医院发挥了重要作用。在总共2856名接受治疗的战斗伤员中，外科部治疗了70例穿透性胸腹战伤患者。38例（54%）为爆炸伤，32例（45%）为枪伤，4例（5.70%）为刺伤。
获取并分析了来自疏散单位、运输、急诊科、手术管理和随访的医疗数据。描述了此类患者的治疗原则，特别提及胸腹联合切开术是最有效的诊断 - 治疗性手术方法。
爆炸伤比枪伤和刺伤多得多（比例为38/32/4）。资源利用分析显示使用了大量血液制品（平均每位患者1250毫升）、补液溶液（平均每位患者3750毫升）以及为期七天的抗菌化学预防（青霉素、庆大霉素、甲硝唑）。受伤至确定性手术修复的平均时间为7小时（范围为1至48小时）。61例（80%）患者出院时康复，9例（13%）患者死亡。
呼吸功能不全和失血性休克的治疗以及感染预防是这些损伤管理的基础。治疗成功取决于紧急急救、快速运输、早期诊断、复苏、手术治疗和重症监护。
