颅脑外伤合并胸腹伤2165例临床分析【临床医学毕业论文设计，精品】.doc

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1、临床医学论文■颅脑外伤合并胸腹伤2165例临床分析作者：涂昌弟陈卫群谭强王刚赵万【摘要】目的寻找颅脑、胸、腹多发伤的最佳治疗途径。方法回顾性分析1993年7月〜2003年6月间收治的2165例颅脑损伤合并胸腹外伤病例。颅脑合并胸部伤733例，腹部伤645例，胸腹联合伤787例，其中294例并发休克。全部病例中重型颅脑伤382例，其中167例合并休克。治疗原则是以抢救生命为主，抓好呼吸、循环、脑受压三个环节，先重后轻，先开放后闭合，颅内血肿脑疝并失血重度休克者两个部位同吋手术。结果总救治成功2024例(93.49%)，总死亡

2、141例(6.51%)，重型颅脑伤无休克者，死亡53例(24.65%)，合并休克者死亡78例(46.71%)。两个部位手术时问完全重叠的患者死亡率58.49%〜65.96%，两个部位手术时间部分错开的患者死亡率28.57%，两者相比差异有显著性(P<0・05)。结论颅脑、胸、腹多发伤的治疗重点是颅内血肿脑疝、休克和呼吸障碍，尤其是两种以上情况同吋发生吋。各部位治疗应相互兼顾，必要时两个部位同时手术但只要病情允许，同时进行的两台手术的开始时间部分错开为宜。关键词颅脑损伤胸腹合并伤临床分析Theclinicalanalysis

3、ofbraininjurycombinedwithchestand/orabdomeninjuryin2165cases[Abstract]ObjectiveTolookforthebestmethodintreatmentoftheeaseswiththebrain'chestandabdomcninjury.Mcthods2165cascsbraininjurywiththechestand/orabdomeninjurywhichwereinhospitaifromJulyl993toJune2003weresumm

4、arizedandresearched.Thepatientswiththeseverebraininjurywcrc382cascs，inwhichl67cascshadshock.Thepatientswithchestinjurywere733cases.Thepatientswithabdomeninjurywere645cases.Thepatientswithbothchestandabdomeninjurywere787cases.Thepatientswithshockwere294caseswhenjus

5、tarrivedthehospita1.Thetreatmentprinciplewastosavethepatients1ifefirstly‘totakeagraspofthethree1inksofbreath'circulationandpressedbrainwell，totreattheseverecasesfirstlybefore1ightcases‘totreatthecaseswithopentraumafirstlybeforecaseswiththeclosedtrauma.Thepatientsw

6、ithbrainherniaoftheintracranialheamatomaandseverehemorrhagicshockwereperformedattwopositionsatthesametime.Results2024cascsweresavedintotalpatients(93.49%)141cascsdied(6.51%).53casesweredeadinpatientsoftheseverebraininjuryshock(24.56%)‘and78casesweredeadwithshock(4

7、6.71%).Thedeathrateofpatientswhosebeginningtimeofthetwopositionoperationswerethesameintotalwasfrom58.49%to65.96%、whosebeginningtimeofthetwopositionopcrationswerepartialstaggerwas28.57%.Thedifferencewassignificantin2groups(P<0.05)・ConclusionThetreatmentofbrain5ches

8、tandabdomenjointinjurywasthebrainherniaoftheintracranialhematoma，shockandbreathobstruction，especiallytwoofwhichoccuratthesametime.Thetrcatmcntsofthediff