损害控制性复苏救治策略联合术后药物调理对严重肝脏损伤伴大出血的治疗效果分析

摘要

目的 探讨损害控制性复苏救治策略联合术后药物调理对严重肝脏损伤伴大出血的救治效果.方法 回顾性分析本院2011年5月至2016年6月收治的300例严重肝损伤伴大出血患者,随机分为对照组和观察组,其中对照组150例,男100例,女50例,年龄21~65岁,平均(42.5±2.1)岁,观察组150例,男100例,女50例,年龄22~64岁,平均(41.0±2.3)岁.观察组采用控制性复苏救治策略(限制性液体复苏、损害控制手术、止血性复苏)联合术后药物调理治疗,对照组仅采用控制性复苏救治策略治疗.结果 对照组150例患者治愈130例,死亡20例,其中1例死于头颅损伤,1例死于心脏功能衰竭.观察组患者治愈150例,治愈率明显高于对照组(P<0.05).观察组150例术后并发症包括切口感染1例、胆瘘2例,术后经抗炎等措施均治愈,对照组治愈的130例中术后并发症包括切口感染4例、胆瘘3例、肝脓肿1例,观察组并发症发生率明显低于对照组(P<0.05).结论 损害控制性复苏救治策略抢救对于肝损害严重并伴有大出血的患者,能及早且最大程度地避免手术期间经常出现的体温不升、代谢性酸中毒和凝血障碍的发生,明显提高患者存活率.在术后及时对患者进行调理,能够促进机体造血功能的恢复,有效改善缺血症状,提高免疫力.损害控制和药物调理两种手段的结合不但能提高严重肝脏损伤伴大出血患者的存活率,还可促进患者术后痊愈.%Objective To discuss the effect of the combination of postoperative drug regimen on severe liver injury and hemorrhage. Method A total of 300 patients with severe liver injury and hemorrhage who received treatment from May 2011 to June 2016 were randomly divided into control group (100 males and 50 females, aged 21 to 65 years, mean (42.5±2.1) years), the observation group of 150 people (100 males and 50 females, aged 22 to 64 years, mean (41.0±2.3) years). The control group was treated with controlled resuscitation strategy (restrictive fluid resuscitation, damage control surgery, hemostatic resuscitation) combined with postoperative drug conditioning treatment. The control group only adopted controlled resuscitation strategy treatment. Result In the control group, 150 patients were cured 130 cases, 20 cases died, one died of craniocerebral injury, the other died of heart failure. The cure rate was significantly higher in the observation group than in the control group (P<0.05). In the observation group, 150 cases were treated with incision infection in 1 case, 2 cases of biliary fistula, 0 cases of liver abscess, postoperative anti-inflammatory and other measures were cured, the control group cured 130 cases of postoperative complications incision infection 4 (P<0.05). The incidence of complications in the observation group was significantly lower than that in the control group (P<0.05). Conclusion For the severe liver injury with massive hemorrhage patients, the application of the method of damage control resuscitation can prevent patients from low temperature, metabolic acidosis and blood coagulation disorders, which can improve the survival rate to a great extend.Treating patients with Iron Sucrose Injection timely after surgery can promote the recovery of hematopoiesis function, improve ischemia symptoms effectively and improve immunity.The method of the damage control resuscitation combined with drug treatment after surgery not only can improve the survival rate of severe liver injury with massive hemorrhage patients, but also promote the recovery of patients after surgery.