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成人腹部刺伤的初步评估及处理

Author
Lee W Shockley, MD, MBA
Section Editor
Maria E Moreira, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM
Translators
谭晓冬, 主任医师，教授

引言

20世纪之前，几乎所有的腹部穿入伤均由非手术方法处理。从第一次世界大战开始，外科医生认识到经过剖腹手术处理的腹部穿入伤士兵死亡率更低。最终，剖腹手术成为了该类创伤的强制性治疗方法。然而，在伴有筋膜穿入但无腹膜炎体征的腹部刺伤(stab wound, SW)中，阴性(即，非治疗性)剖腹手术率高达82%[1]。人们逐渐意识到，战时腹部穿入伤(主要是高速枪击伤及燃烧装置引起的创伤)与平时腹部穿入伤(主要是刺伤及低速枪击伤)有所不同。20世纪60年代，Shaftan对所有腹部穿入伤必须进行剖腹手术这一教条式处理方法提出质疑，从那时起腹部刺伤的剖腹手术率开始下降[2]。

本专题将讨论腹部刺伤的初步评估及处理。普通创伤复苏和处理、腹部钝挫伤、腹部枪击伤及创伤的其他相关内容见其他专题。 (参见“成人创伤的早期处理”和“成人腹部钝挫伤的初始评估和处理”和“成人腹部枪伤的初步评估和处理”)

流行病学

虽然引起腹部创伤的损伤机制存在显著的地区差异性，但许多研究证实，在平民百姓中腹部钝挫伤比腹部刺伤更常见，而腹部刺伤比腹部枪击伤更常见[3-6]。然而，腹部枪击伤的死亡率是腹部刺伤的8倍[6]。这可能是因为刺伤的动能比枪击伤更小。

腹部刺伤最常伴随空腔脏器损伤，这在儿童及成人中并无差异[3,7,8]。其次最常损伤的结构是大血管、横膈、肠系膜、脾脏、肝脏、肾脏、胰腺、胆囊及肾上腺。刺伤的部位决定了具体哪个器官受到损伤的风险最高。

损伤机制

任何可进行刺穿的物体均可造成刺伤。这些通常是细的、锋利的、像刀一样的器具，但是从剪刀到衣架再到动物的角均可造成刺伤。特定器具可损伤其穿过的任何组织，包括皮肤、筋膜、实体器官、空腔脏器、血管和骨。

                      

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Literature review current through: 2017-06 . | This topic last updated: 2016-10-03.
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