骨盆骨折伴血流动力学不稳定患者的外固定治疗(2)-找论文网

3 重视合并伤的救治

部分学者对不稳定骨盆骨折患者死于血液动力学不稳的观点持有异议。人们已经注意到外固定架在紧急救治时的使用能够降低死亡率。这种观念是基于如下直接的理解：骨盆骨折病人多数死于大出血，减少骨盆出血将降低死亡率。然而骨盆骨折患者死亡经常是因为伴发伤的结果。Kobziff等［23］报道不稳定骨盆骨折死亡率达30％，其中10%～12％由于失血造成。Poole等报道在236例骨盆骨折患者中仅有1例死于出血，这些患者的预后是由合并伤而非骨盆骨折决定。Young等报道侧方挤压损伤病人死亡的主要原因是头颅闭合伤，前后挤压伤患者死亡主要由于骨盆出血和内脏损伤。Gruen等研究的312例骨盆骨折的患者死亡率是11％，这是合并伤而非不可控制的出血的结果。骨盆骨折外固定架降低患者死亡率的机制需要进一步深入探讨。

因此在急诊救治中应在控制出血、改善血流动力学不稳定的同时，积极救治合并伤，降低患者死亡率，改善患者预后。

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