摘要近年来,应用"损伤控制性外科"来救治一些危重的创伤患者取得了较大的成功.我们认为,损伤控制性外科这一理念也同样适用于胃肠外科危重患者的救治,因为这些危重患者与创伤患者有类似的病理生理改变--即低温、酸中毒和凝血功能障碍,这"致命三联"形成一个恶性循环,使得患者不能承受传统的常规大手术打击.对于胃肠外科危重患者,实施损伤控制性外科的理念,总体原则应该是先用最小的方式解决出血、梗阻和感染等危及生命的病况,待患者病情稳定后,再择期行确定性手术,从而提高患者的存活率.具体可分为3阶段,第一阶段:急诊手术用最小的创伤解决出血、梗阻和(或)感染等问题,改善患者状况;第二阶段:在监护病房恢复措施包括稳定血流动力学、纠正凝血功能障碍及酸中毒、复温和机械通气等;第三阶段:择期行确定性手术.

abstractsIn recent years, damage control is well established as a potentially life-saving procedure in a few selected critically injured patients. The "damage control"concept also has been shown to increase overall survival and is likely to modify the management of critically illed patients suffering from gastrointestinal disease. In these patients the "lethal triad" of hypothermia, acidosis, and coagulopathy acts as a vicious cycle that often can not be interrupted and marks the limit of the patient's ability to cope with the physiological consequences of traditional and extensive surgical procedures.The principles of damage control are to control bleeding,obstruction,and/or infection until the physiologic derangement has been restored and the patient could undergo a prolonged operation for definitive repair. This approach is unfolded in three phases. During the initial operation, the surgeon carries out only the absolute minimum necessary to improve patient's condition and to control bleeding, obstruction, and/or infection.The second phase consists of secondary resuscitation in the intensive care unit, characterized by maximization of hemodynamics, correction of coagulopathy, rewarming, and complete ventilatory support. During the third phase, definitive operation is performed.