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成年创伤患者院内处理概述

Author
Babak Sarani, MD, FACS, FCCM
Section Editor
Heidi L Frankel, MD, FACS
Deputy Editor
Kathryn A Collins, MD, PhD, FACS
Translators
汤文浩, 主任医师，教授

引言

在美国，创伤是44岁以下年龄人群的主要死因，也是45岁以上年龄人群的前5位死因之一。创伤性损伤患者的处理具有多种挑战。大多数患者在收入住院前都在急诊科接受了多学科评估、复苏和病情稳定的处理，也可能接受了手术干预。患者可能会因存在未发现的损伤，或因相关初始或后续的处理，而仍有并发症的风险。

本专题将对需住院的创伤患者的一般治疗和处理进行总结。急诊科的初始评估和治疗将单独讨论。特定创伤将单独在其他专题讨论。 (参见“成年创伤患者的院前急救”和“成人腹部钝挫伤的初始评估和处理”和“成人钝性胸部损伤的初步评估和处理”)

患者评估

持续的院内评估和监测对创伤患者的处理至关重要。对已经接受过损伤控制手术的患者和接受非手术性处理的损伤患者(如钝性脾损伤、肝损伤、十二指肠损伤或胰腺损伤)来讲尤其如此。识别创伤性损伤的完整范围需要准确的病史采集、熟练的体格检查以及及时正确地选用诊断检查。

全面病史采集 — 严重创伤患性损伤者在被送入急诊科时往往不能提供详细的既往病史，通常最初也可能无法从其他渠道(如家属或朋友)获得相关信息。因此，必须依靠收治入院的医师来获取患者的额外信息，包括既往病史、门诊用药、过敏史以及任何酒精和药物使用史。准确的病史信息除了对优化医学处理有价值以外，对评估患者预后也有价值。 (参见下文‘结局’)

获取导致损伤的情景的相关信息也非常重要，因为从高处跌落或车祸可能是由医学原因(如心律失常、低血糖症或脑卒中)引起，而殴打损伤则可能是家庭暴力的结果。此外，自我造成的损伤可能是心理障碍的表现，需要医生加以甄别，并予以治疗。

                                             

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Literature review current through: 2017-06 . | This topic last updated: 2016-10-04.
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