腹部手术在战斗损伤中的特点,我们的经验

A. Minasyan, H. Minasyan, D.R. Arazyan, A. Aleksanyan, E.A. Harutunyan
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引用次数: 0

摘要

研究在合格外科救助阶段的医院进行,患者在战场上接受急救后立即转移。所有患者入院后立即接受分诊专家检查,按公认标准评估呼吸和血流动力学指标。多数为多发伤合并严重失血性休克。所有受伤的病人都接受了紧急手术。第一组患者有孤立损伤或合并损伤,但血流动力学参数相对稳定,进行了大量干预,不需要再开腹手术(最终手术)。第二组患者合并重症;血流动力学指标不稳定。手术入路遵循“损伤控制”原则。按照上述方式安排工作,可以根据病人流动的强度和现有资源的数量,不间断地按时提供合格的医疗服务。对于下一阶段的医疗后送,我们选择的策略是可以理解的,因为它可以避免第一类患者的额外的双重手术攻击,只需要应用“随叫随到”的原则。对于第二组患者,在某些情况下,可以推迟“程序性再开腹手术”,并在对患者更有利的条件下进行。在任何情况下,在提供合格的手术护理时,都应该考虑到在这一阶段进行的干预对于下一阶段的外科医生来说应该是可预测的,也就是说他们应该了解我们应用了什么原则,这样他们就可以按照同样的原则继续治疗。
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Features of abdominal surgery in combat injuries, our experience
The research was carried out in the hospital of the qualified surgical aid stage, where the patients were transferred immediately after receiving first aid from the battlefield. Immediately after admission, all the patients were examined by triage specialists, respiratory and hemodynamic indicators were evaluated according to accepted standards. Most of the injuries were combined polytraumas with severe hemorrhagic shock. All the injured patients were urgently operated. In first group patients who had isolated injuries or combined injuries, but relatively stable hemodynamic parameters, a volume of interventions was performed, which does not require relaparotomy (definitive surgery). Second group patients had combined severe injuries; hemodynamic indicators were unstable. The surgical approach was in accordance with the principle of “damage control”. The organization of work in the mentioned way made it possible to provide qualified medical care without interruption and on time, depending on the flow intensity of patients and the volume of available resources. For the next stages of medical evacuation, the strategy we chose was understandable, due to which it was possible to avoid additional double surgical aggression in case of first group patients, only by applying the “relaparotomy on demand” principle. In case of second group patients, in some cases, it was possible to postpone the “programmed relaparotomy” and to carry it out in more favorable conditions for the patient. In all cases, when providing qualified surgical care, it should always be taken into account that the intervention performed in this stage should be predictable for the surgeons working at next stage, that is they should understand what principle we have applied, so that they can continue the treatment with the same principle.
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