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目的:探讨颅脑等全身多器官损伤合并颌骨骨折患者的临床救治。方法:对56例颅脑等全身多器官损伤合并颌骨骨折患者的院前急救,入院时Glasgow昏迷评分,入院后的救治以及相关预后进行分析。结果:56例中,颅骨骨折20例,脑震荡伤2例,脑损伤54例,合并全身损伤38例,合并颌骨骨折45例。院前体征昏迷41例,出血20例,恶心呕吐15例,大小便失禁10例。院前急救处理:清创缝合16例,气管切开3例,胸腔闭式引流3例,骨折牵引3例,各种相应处理31例。入院时Glasgow昏迷评分GCS13～15者20例,GCS8～12者10例,GCS5～7者26例。入院后立即施行开颅手术或气管切开术10例,采取保守治疗46例。病情稳定后施行颅脑或全身手术11例,施行颌骨骨折切开复位+钛板内固定术41例。预后情况,本组无死亡病例,所有病例生命体征稳定,失语1例,运动障碍1例,视力丧失1例,听力下降1例,颌骨骨折复位固定术后咬合关系恢复正常及良好者40例。结论:颅脑等全身多器官损伤合并颌面部损伤者的急救应遵循①.影响生命体征时“先全身,后口腔”;②.不影响生命体征时应“全身与口腔并举”;③.颌面部损伤重,全身损伤轻时应“先口腔,后全身”的原则。
Objective: To explore the clinical treatment of craniocerebral multiple organ injury patients with jaw fracture. Methods: Fifty-six patients with craniocerebral multiple organ injury complicated with jaw fracture, prehospital first aid, Glasgow coma score at admission, treatment after admission, and related prognosis were analyzed. Results: In 56 cases, there were 20 cases of skull fracture, 2 cases of concussion injury and 54 cases of brain injury. 38 cases were complicated with total body injury and 45 cases were complicated with jaw fracture. 41 cases of coma before hospital signs, bleeding in 20 cases, nausea and vomiting in 15 cases, incontinence in 10 cases. Pre-hospital emergency treatment: debridement and suture in 16 cases, tracheotomy in 3 cases, thoracic drainage in 3 cases, fracture traction in 3 cases, a variety of corresponding treatment in 31 cases. On admission, Glasgow coma score GCS13 ~ 15 in 20 cases, GCS8 ~ 12 in 10 cases, GCS5 ~ 7 in 26 cases. Ten patients underwent craniotomy or tracheotomy immediately after admission, and conservative treatment was performed in 46 patients. After the condition was stabilized, craniocerebral or systemic surgery was performed in 11 cases, maxillary fracture reduction and open reduction + titanium plate fixation in 41 cases. Prognosis, no deaths in this group, all cases of vital signs stable, aphasia, dyskinesia in 1 case, loss of vision in 1 case, 1 case of hearing loss, reduction and fixation of mandibular fracture occlusal relationship returned to normal and good in 40 cases . Conclusions: The first aid of craniocerebral and other multiple organ injury patients with maxillofacial injury should be followed.1. When affecting vital signs “first systemic and posterior oral cavity ”; “; ③ maxillofacial injury, light body injury should be” first oral, after the whole body "principle.