中国口腔颌面外科杂志

中国口腔颌面外科杂志 ›› 2019, Vol. 17 ›› Issue (1): 70-73.doi: 10.19438/j.cjoms.2019.01.014

• 临床总结 • 上一篇    下一篇

20例颅颌面部为主的多发伤救治体会

葛奎1, 吴嘉骏1, 钱立1, 王繁麟1, 范晶娴1, 梁翔2, 史俊3, 张诗雷3, 谢挺1, 徐兵1   

  1. 1.上海交通大学医学院附属第九人民医院 急诊科, 上海 200011;
    2. 上海交通大学医学院附属第九人民医院 胸外科,上海 200011;
    3. 上海交通大学医学院附属第九人民医院 口腔颅颌面科,上海 200011
  • 收稿日期:2018-07-09 修回日期:2018-08-15 出版日期:2019-01-20 发布日期:2019-02-21
  • 通讯作者: 吴嘉骏,E-mail:bigduff@sina.com
  • 作者简介:葛奎（1971-）,男,博士,副主任医师,E-mail:kge723@163.com
  • 基金资助:
    上海市卫计委重要薄弱学科建设基金（2016ZB0203-01）; 上海申康医院发展中心临床管理优化项目（SHDC2016626）; 上海交通大学医工交叉课题（YG2016MS12）

Treatment of multiple cranionmaxillofacial trauma: experience in 20 consecutive cases

GE Kui1, WU Jia -jun1, QIAN Li1, WANG Fan-lin1, FAN Jing-xian1, LIANG Xiang2, SHI Jun3, ZHANG Shi-lei3, XIE Ting1, XU Bing1   

  1. 1. Department of Emergency,Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China;
    2. Department of Cardiothoracic Surgery,Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China;
    3. Department of Oral and Craniomaxillofacial Surgery,Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China
  • Received:2018-07-09 Revised:2018-08-15 Online:2019-01-20 Published:2019-02-21

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摘要： 目的 探讨颅颌面部为主多发伤的救治策略。方法 回顾分析2013年3月—2018年3月间收治的20例颅颌面部为主多发伤患者（男16例,女4例;年龄9~83岁,平均40.8岁）的救治情况,包括早期急救、组织器官损伤、损伤控制性手术开展、功能恢复或重建、创面愈合以及预后情况。结果 20例患者中,初级生命支持情况分别为急诊清创止血19例,单纯液体复苏13例,大量液体复苏+输血4例,气管插管或切开5例,外固定（石膏或骨牵引）4例。损伤情况分别为2处损伤3例,3处损伤4例,4处损伤7例,损伤5处及以上6例。损害控制性手术开展情况分别为损伤控制性手术10例,其中,眼球探查修补1例,颅内血肿清除及去骨瓣减压1例,剖胸探查止血+肺裂伤缝合+胸腔闭式引流1例,介入止血1例,骨牵引外固定2例,创面修复（清创后负压封闭创面）4例。EICU继续高级生命支持情况分别为6例患者在抢救室经初级生命支持后,生命体征稳定而直接转入专科,做确定性手术治疗;14例患者由抢救室转入EICU继续高级生命支持,其中10例病情稳定后联合专科行早期确定性手术,4例病情严重无法早期确定性手术患者伤情稳定后直接出院,后续行整形或功能重建。20例患者全部存活,无死亡。结论 实现急诊急救一体化,早期器官功能支持,是颅颌面部严重创伤成功救治的重要策略之一。

关键词: 颅颌面部创伤, 多发伤, 生命支持, 损伤控制外科

Abstract: PURPOSE: To discuss the treatment strategies of severe multiple craniomaxillofacial trauma. METHODS: Twenty patients (16 males and 4 females, ranged from 9 to 83 years old, with an average age of 40.8 years old) with severe multiple cranionmaxillofacial trauma treated in Emergency Intensive Care Unit (EICU) of Shanghai Ninth People's Hospital were retrospectively analyzed from Mar. 2013 to Mar. 2018. The injury situation, treatment method and outcome, including basic life support given in first-aid room, number of injury site, damage control operation, advanced life support method in EICU, the resuscitative results and the outcome, were reviewed and analyzed. RESULTS: As basic life support, 19 patients were given debridement and hemostasis, 13 patients only received liquid resuscitation, 4 patients had blood transfusion after massive liquid resuscitation, 5 patients underwent intubation /tracheotomy, 4 patients had external fixation. For the number of injury site, 3 patients had 2 injury sites, 4 patients had 3 injury sites, 7 patients had 4 injury sites, 6 patients had 5 or more injury sites. For damage control operation, 10 patients were given damage control operation, 1 patient was given orbital exploratory operation, 1 patient underwent intracranial hematoma removal and decompressed craniectomy, 1 patient had lung repair and drainage after exploratory thoracotomy and hemostasis, 1 patient had hemostasis by percutaneous intervention, 2 patients had external fixation, 4 patients' wound were repaired by covering with native pressure after debridement. For advanced life support in EICU, 6 patients were admitted directly to operate in different departments, the others 14 patients were transferred to EICU to be given advanced life support. During the time in EICU, 10 patients were given operation by different disciplines after vital signal becoming normal, 4 patients discharged and waited for plastic surgery later because missing best chance. All patients were recovered to normal condition without death. CONCLUSIONS: Multidisciplinary co-operation and continuous life support earlier are the most important strategies for severe multiple craniomaxillofacial trauma.

Key words: Craniomaxillofacial trauma, Multiple trauma, Life support, Damage control surgery

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