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《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:

期数:

2024年02期

页码:

201-206

栏目:

论著

出版日期:

2024-04-20

文章信息/Info

Title:

Single-center critical care of severe blast injuries

作者:

谢开晶¹; 2; 白伟志²; 王 震¹; 李 婷³; 邵世锋¹; 王耀丽¹

400042 重庆,陆军军医大学大坪医院创伤与化学中毒全国重点实验室¹
400042 重庆,重庆西区医院重症医学科²
400042 重庆,陆军军医大学大坪医院麻醉科³

Author(s):

Xie Kaijing¹; 2;  Bai Weizhi²;  Wang Zhen¹;  Li Ting³;  Shao Shifeng¹;  Wang Yaoli¹.

¹State Key Laboratory of Trauma and Chemical Poisoning, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, China; ²Intensive Care Unit, Chongqing West District Hospital, Chongqing, 400042, China; ³Department of Anesthesiology, Daping Hospital, Army Medical University, Chongqing, 400042

关键词:

爆炸伤;  原发性爆炸肺损伤;  损害控制性复苏;  重症监护

Keywords:

Blast injuries;  Primary blast lung injury;  Damage control recovery;  Intensive care

分类号:

R563

DOI:

10.3877/cma.j.issn.1674-6902.2024.02.006

摘要:

目的 分析严重爆炸伤临床特点及对重症的监护与救治。方法 选取2011年9月至2022年8月我院收治的9例严重爆炸伤患者为对象。收集临床资料包括:性别、年龄、致伤机制、诊断、急性生理与慢性健康评分(acute physiology and chronic health evaluation, APACHE Ⅱ)、伤害严重程度评分(injury severity score, ISS)、格拉斯哥昏迷评分(glasgow coma score, GCS)、ICU住院时间、损伤部位、手术方式和时间、血液制品使用、机械通气、血管活性药物和抗凝药物使用、肾脏替代治疗和感染情况,比较治疗前后实验室指标。结果 9例患者平均重症医学科(intensive care unit, ICU)住院时间(32.0±24.9)d。有创呼吸支持7例(77.78%),呼吸机使用时间(21.4±20.9)d。使用血管活性药物5例(55.56%),使用时间(7.4±6.6)d。有创动脉血压(invasive arterial blood pressure, IABP)和中心静脉压(central venous pressure, CVP)监测8例(88.89%)。不同程度凝血功能障碍9例,成分输血6例(66.67%),早期使用肝素(heparin, Hep)或低分子肝素(low molecular weight heparin, LMWH)抗凝治疗8例(88.89%)。使用抗生素9例,使用时间(17.3±12.7)d。连续肾脏替代治疗(continuous renal replacement therapy, CRRT)4例(44.44%),CRRT治疗时间(7.2±5.1)d。早期(48 h)行肠内营养支持6例(66.67%)。治疗后D-二聚体(D-Dimer, D-D)、K值、肌酸激酶同工酶杂合体(creatine kinase isoenzymes-MB, CK-MB)、肌红蛋白(myoglobin, MYO)、心肌肌钙蛋白I(cardiac troponin I, cTnI)、总胆红素(total bilirubin, TBil)、间接胆红素(indirect bilirubin, IBil)、门冬氨酸氨基转移酶(aspartate aminotransferase, AST)、乳酸脱氢酶(lactate dehydrogenase, LDH)、血清肌酐(serum creatinine,SCr)、乳酸(lactic acid, Lac)、白细胞计数(white blood cell count, WBC)、中性粒细胞计数(neutrophil count, NE)、超敏C反应蛋白(hypersensitive C-reactive protein, hs-CRP)和降钙素原(procalcitonin, PCT)较治疗前降低(P<0.05)。治疗后血细胞比容(hematocrit, HCT)、血小板计数(platelet counts, PLT)、α角(angle)、MA值和淋巴细胞计数(lymphocyte count, LY)升高(P<0.05)。康复出院8例(88.89%),持续性植物状态ICU长期治疗1例(11.1%)。结论 严重爆炸伤经历复杂情况和挑战性治疗。ICU内实施全面、系统救治可改善严重爆炸伤实验室指标和预后。

Abstract:

Objective To analyze the clinical characteristics of patients with severe explosion injuries and the monitoring and treatment of severe injuries. Methods Nine patients with severe explosion injuries admitted to our hospital from September 2011 to August 2022 were selected as the subjects. The clinical data was collected: gender, age, injury mechanism, diagnosis, acute physiology and chronic health evaluation(APACHE Ⅱ), injury severity score(ISS), Glasgow coma score(GCS), ICU length of stay, injury site, surgical method and time, use of blood products, mechanical ventilation, use of vasoactive drugs and anticoagulants, renal replacement therapy and infection, Pre-and post-laboratory parameters were analyzed. Results The average hospitalization time of the 9 patients in the Intensive Care Unit(ICU)was(32.0±24.9)days. There were 7 cases(77.78%)with invasive respiratory support for(21.4±20.9)days. Vasoactive drugs were used in 5 cases(55.56%)for(7.4±6.6)days. invasive arterial blood pressure(IABP)and central venous pressure(CVP)were detected in 8 cases(88.89%). There were 9 cases with different degree of coagulation dysfunction, 6 cases(66.67%)with component transfusion, and 8 cases(88.89%)with early anticoagulation treatment with heparin(Hep)or low molecular weight heparin(LMWH). 9 cases were treated with antibiotics for(17.3±12.7)days. Continuous renal replacement therapy(CRRT)was performed in 4 patients(44.44%), and the duration of CRRT treatment was(7.2±5.1)days. In the early stage(48 h), 6 cases(66.67%)received enteral nutrition support.D-Dimer(DD), K value, creatine kinase isoenzymes-MB(CK-MB), myoglobin(MYO), and cardiac troponin after treatment Protein I(cardiac troponin I, cTnI), total bilirubin(TBil), indirect bilirubin(IBil), aspartate aminotransferase(AST), lactate dehydrogenase(lactate dehydrogenase, LDH), serum creatinine(SCr), lactic acid(Lac), white blood cell count(WBC), absolute neutrophil count(ANC), ultrasonic The levels of hypersensitive C-reactive protein(hs-CRP)and procalcitonin(PCT)were significantly lower than those before treatment(P<0.05). In addition, hematocrit(HCT), platelet(PLT)count, alpha angle(angle), MA value and absolute lymphocyte count(ALC)increased after treatment(P<0.05). Eight cases(88.89%)were discharged after recovery, and one case was under long-term monitoring and treatment in the ICU due to persistent vegetative state. Conclusion Severe blast injuries are complex and challenging to treat. Comprehensive and systematic treatment in the ICU can improve laboratory indicators and prognosis of severe blast injuries.

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备注/Memo

备注/Memo:

基金项目: 重庆市技术创新与应用发展专项重点项目(CSTC2021jscx-gksb-N0007) 通信作者: 邵世锋, Email: shaosfoliver@163.com 王耀丽, Email: wangylchen2005@aliyun.com

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更新日期/Last Update: 2024-04-20