Damage control resuscitation of severe multiple trauma in the pelvic fractures
10.3969/j.issn.1003-0034.2015.05.003
- VernacularTitle:骨盆型严重多发伤的损伤控制复苏
- Author:
Guo Chang FU
1
Author Information
1. 河南省煤炭总医院骨科
- Keywords:
Damage control resuscitation;
Pelvis;
Fractures;
Shock,hemorrhagic
- From:
China Journal of Orthopaedics and Traumatology
2015;(5):399-403
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To discuss the clinical effects of damage control resuscitation(DCR)in treating severe multiple trauma in the pelvic fractures. Methods:From March 2009 to September 2013,a restrospective analysis was conducted on the clinical data of 28 patients with multiple trauma in the pelvic fractures,including 19 males and 9 females,ranging in age from 21 to 51 years old with an average of 32.5 years old. According to Tile classification of pelvic fractures,16 cases were type B and 12 cases were type C. Injury severity score(ISS)averaged 32.0±3.4. All cases were treated with damage contral orthopae?dics and DCR strategy,namely that used immediately with small capacity of balanced salt solution on admission so as to main?tain the blood pressure between 80 to 90 mmHg. At the same time,emergency phaseⅠsimple debridement plus external fix?ator or bundled with fixed pelvic was done,and the chest or abdomen combined injury was treated at first. And limbs fracture was temporary dealing with bone traction or plaster external fixation,etc. After bleeding was controlled by operation,fluid re?suscitation was done as fast as possible and the plasma was transfused early according to the proportion of plasma and red cell suspension(2 U∶1 U-3 U∶2 U). Dosage of balanced salt solution and blood before remedy shock was recorded,and the re?moval of time of lactic acid and coagulation were observed. Results:Five cases were died after 4 to 15 hours into hospital(3 cases died for severe trauma hemorrhagic shock and 2 cases for acute respiratory distress syndrome). Twenty three cases were remedy shock at 1.6 to 4.3 hours after injury with an average of 2.4 hours. Period I operation duration was(78.2±10.3)min?utes. Dosage of balanced salt solution was(3 798 ± 340)ml and red cell suspension was 14 to 18 U,fresh frozen plasma (FFP)was(1 267±58)ml(1U FFP=100 ml),blood platelet was 8 to 12 U for 9 patients. The removel time of lactic acid and PT-APTT was(11.4 ± 2.1)hours and(4.3 ± 0.8)hours. Measures were taken to correct electrolyte and acid base imbalance was normal. The success rat of recovery was 82.2%(23/28). Conclusion:Damage control resuscitation(DCR)integrates the main links such as damage control operation and allowable low blood pressure(or limited liquid resuscitation)and hemostatic control resuscitation,was early effective treatment measures for the patients with severe multiple trauma in the pelvic fractures.
