损伤控制策略在ICU中的应用及其价值研究

摘要

目的 重症监护病房(intensive care unit,ICU)应用损伤控制策略对严重多发伤患者的救治及ICU在损伤控制策略中的价值研究.方法 回顾性分析该院ICU 2007年1月～2010年12月创伤严重度评分(injury severity score,ISS)大于25分的42 例严重多发伤的病人应用损伤控制策略进行救治.观察机械通气使用情况、多器官功能障碍综合症(MODS)发生情况和病死率,并根据APACHE II评分法进行死亡危险性预测(预测死亡概率,Ps)与实际死亡率分析.结果 42例患者中33例使用机械通气,发生MODS 21例,经ICU治疗9例逆转;死亡12例(28.57%),而 APACHE II评分预测死亡概率22例(52.38%),病死率减少,χ2=4.94,P＜0.05.结论 ICU对严重多发伤患者的救治和改善其预后有着重要的价值,应树立损伤控制ICU的理念.%Aim To explore the clinical value of applying damage control strategy to patients with severe multiple trauma and the clinical rnvalue of intensive care unit in damage control strategy. Methods From January,2007 to December,2010,42 patients with severe multirnple trauma whose injury severity scores were all over 25 points were treated by applying damage control strategy. These cases were retrornspectively analyzed. We observed the use of mechanical ventilation, occurrence and mortality of multiple organ dysfunction syndrome. We rnapplied APACHE Ⅱ scoring system to predict death risk and analyzed actual mortality. Results 33 patients were mechanically ventilarnted. MODS occurred in 21 patients. After they were treated in ICU,9 patients were improved and 12 were dead(28.57％ ) ,but 22 parntients(52.38％ )were predicted to be dead applying APACHE Ⅱ scoring system. Therefore,mortality decreased(x2 = 4.94,P ＜0.05).rnConclusion ICU was very valuable in treating patients with severe multiple trauma and improving these patients' prognosis. We should rnestablish the concept of damage control in ICU.