医药学论文：部分特殊型严重大血管损伤的救治

【摘要】 目的 探索和提高严重大血管损伤的救治水平。方法 对1990年1月～2004年12月收治的33例颈、腹和四肢特殊型严重大血管损伤的临床资料进行总结分析。结果 存活31例，死亡2例，抢救成功率93.94%，平均随访6.8年，均治愈，无并发症。结论 抢救初期要注意进行有效的心肺复苏、压迫止血和快速进行深静脉插管；颈动脉转流管在严重颈动脉损伤重建过程中有重要作用；对长距离颈动脉损伤用颈外静脉移植外环包人造血管重建，可取得最佳效果；对肝静脉及肝后下腔静脉损伤，要充分暴露，采用有效方法止血和修复，对病情极危重的凶险性出血者，血液转流泵的应用可提高成功率；对大、中血管（尤其是静脉）损伤，两端均为裤式单开口自体双血管移植，解决了无适宜口径自体移植血管和应用人造血管远期易闭塞等问题；对深静脉损伤并广泛血栓形成者，应用改进的Fogarty导管和顺行插管取栓法，可有效取栓并避免了副损伤。
【关键词】 血管 损伤 救治 移植 重建
Treatment of part specific severe vessels injury
【Abstract】 Objective To probe and raise the treatment level of serious great vessels injury. Methods The clinical materials of 33 patients with neck， abdomen and limbs having specific severe vessels injury，who were treated from January 1990 to December 2004 were summarized and analyzed.Results The survival was 31 cases， the death was 2 cases，the rate of success of emergency treatment was 93.94%， the average follow-up was 6.8 years， they were all cured， and had no complications.Conclusion To pay attention to carry out effective cardiopulmonary resuscitation， hemostasis by compression and deep vein intubation rapidly in the initial stage of emergency. The carotid shunt tube plays an important role in severe carotid injury and re-establishment process. We use external jugular vein to transplant and re-establish，which are rung with artificial blood vessels for the long distance carotid injury and achieved the best result. We expose as fully as possible for the hepatic venae and the posthepatic post caval injury，and adopt effective methods to stop bleeding and repair. The application of blood shunt pump could raise the success rate for those severe patients. The self-double vastransplantation with both ends being all trousers-style one opening solve some problems such as there are no suitable caliber self-transplantation blood vessels and the artificial blood vessels are easy to occur obliteration for long-term and so on for the great or middle blood vessels (especially vein).We use improved Fogarty duct and anterograde intubation to eliminate thrombus could eliminate thrombus effectively and avoid accessory injury for the deep vein injury and extensive thrombosis.
【Key words】 blood vessel injury treatment transplantation re-establishment
我院于1990年1月～2004年12月，共收治特殊型严重大血管损伤33例，其中颈部大血管严重损伤8例，腹部大血管严重损伤15例，四肢大血管严重损伤10例。针对此类病例伤情严重、特殊，死亡、致残率极高及临床救治棘手等问题，笔者采取了果断和特殊的救治措施和方法，取得了良好的临床效果，报告如下。