【关键词】 烧伤；腹部外伤；经验总结
The analysis of diagnosis and treatment on burn with abdominal trauma
【Abstract】 Objective To summarize the notable problems of the diagnoses and treatment of burn with abdominal trauma by the clinical analysis of the related cases.Methods The clinical diagnosis and treatment course of the four typical burn with abdominal trauma cases were retrospectively analyzed and the experiences were summarized.Results The four typical burn with abdominal trauma patients were survival after the related diagnosis and treatment,but they had the respective specificity in the earlier period.Conclusion During the period of the diagnosis and treatment,we shouldn’t ignore the abdominal symptoms and physical signs of the burn with abdominal trauma patients. We should get the messages rapidly and give the related auxiliary examination to the patients to identify the diagnosis in order to put the best treatment into practice.
【Key words】 burn; abdominal trauma; summary of experiences
本文回顾性分析4例有代表性的烧伤合并腹部外伤的病例的临床诊疗经过，总结诊治经验。现报告如下。
1 临床资料
1.1 病例1
患者，男，10岁。因燃放鞭炮时将鞭炮投入卡油箱而致“面、颈、胸、腹部及双上肢火焰烧伤，半小时”入院。入院诊断：全身多处火焰烧伤面积达23%，深Ⅱ°9%，浅Ⅱ°14%。入院后2h诉有轻度上腹痛，患儿及父母提示患儿伤前有间歇性腹痛表现。当时考虑有“应激性溃疡”而给予抑酸药。入院后12h，腹痛加重，BP下降至70/40mmHg，HR 120次/min。立即行腹腔穿刺，抽出不凝固血性液体，B超检查提示腹腔积血超过500ml，肝右叶有裂伤存在。追问病史发现患儿有被油箱盖击中右上腹的病史(原来患儿投放鞭炮时曾将油箱盖盖上，油箱爆炸，箱盖飞驶击中)。急诊于气管插管全麻下行剖腹探查术，术中发现肝右叶膈面有5.0cm×1.5cm大小破裂口，有凝血块堵塞，腹腔积血约800ml，术中行肝破裂修补术。术后常规治疗，28天病愈出院。
1.2 病例2
患者，女，46岁。因房屋着火而致“头面、胸腹、四肢火焰烧伤20min”入院。入院诊断：头面、胸腹、四肢火焰烧伤33%，Ⅲ°11%，深Ⅱ°12%，浅Ⅱ°10%。入院后，患者诉有左上腹痛，体检：左肺下界抬高，呼吸音减弱，右肺基本正常，腹微隆，腹肌稍紧，左上腹有压痛，反跳痛不明显。1h后，患者血压降至70/40mmHg。反复询问病史，诉有左上腹重物倒下压伤史。立即行腹腔穿刺，抽出不凝固血性液体。考虑有腹腔脏器破裂，当即在气管插管全麻下行剖腹探查术。术中发现：脾中央型破裂，膈肌左侧破裂，脾、胃及部分肠管疝入左侧胸腔，腹腔积血约1800ml，心、肺及腹腔其余脏器未见异常。术中行脾切除术、膈肌修补术，自体血回输。术后病人生命体征渐平稳，给予常规治疗，35天病愈出院。
1.3 病例3
患者，男，37岁。因煤气着火致“头面颈部、四肢火焰烧伤2h”入院。入院诊断：全身多处火焰烧伤29%，深Ⅱ°20%，浅Ⅱ°9%。入院后患者一直诉满腹疼痛，并出现恶心、呕吐，呕出物为胃内容物，未见明显异常物质。查体：BP 110/80mmHg，腹肌紧张，满腹有压痛及反跳痛，未叩及移动性浊音。腹穿阴性，腹部X线片未见膈下游离气体，B超未提示腹腔有明显异常。对症处理后，患者腹痛无好转，并且进行性加重，呈持续性剧烈腹痛，压痛、反跳痛更加明显。追问病史，诉有腹部撞击史。考虑有空腔脏器损伤，急诊行剖腹探查术，术中发现远端空肠有一处1.5cm×1.0cm大小穿孔，术中行小肠修补术。术后常规治疗，28天伤愈出院。