危機における意思決定: 切断のタイミングと,重度の下肢外傷における短期的な結果

Aryan Rafieezadeh¹, Kartik Prabhakaran¹, Rishwanth Vetri¹

¹Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, New York.

The Journal of surgical research

|February 13, 2026

まとめ

重度の下肢損傷の早期の切断は,合併症と入院期間を軽減します. このアプローチは,遅延の手続きと比較して,より多くの自宅放出を含む,より良い結果につながります.

科学分野:

トラウマ・外科・外科
整形外科整形外科
緊急医療緊急医療

背景:

末肢の切断は,下肢の重度の怪我の管理において重要な決定です.
切断が遅れた場合,合併症率が高くなり,患者の治療結果に悪影響を及ぼす可能性があります.

研究の目的:

孤立した,鈍い重度の下肢損傷を有する患者の早期 (≤48時間) と遅い (>48時間) の截肢の結果を比較するために.
タイミングが死亡率,合併症,入院期間,退院処分に与える影響を評価する.

主な方法:

トラウマ品質改善プログラム (2017~2021年) の遡及レビュー
孤立した重度の鈍い下肢損傷 (略称傷害スケール ≥3) を有する患者,截肢手術を受けた患者を含む.
早期および遅期の断肢グループに分層し,その後,傾向スコアのマッチングを行います.

主要な成果:

死率は,早期と後期の截肢グループ (P = 0.06) の間で類似していました.
早期の切断は,急性腎臓損傷,骨髄炎,計画外の挿管,計画外のICU入院,そして手術室への戻り率の有意に低い割合と関連していました.
早期の截肢手術を受けた患者は,病院と集中治療室 (ICU) の滞在期間が短縮され,自宅への退院率が上昇しました.

結論:

下肢の重度の不快な損傷における早期の切断は,より少ない合併症と関連しています.
短期間の入院やICUの滞在は,早期の截肢で観察されています.
適時な断肢は退院の準備を改善し,施設でのケアよりも自宅での退院を好む.

キーワード:

合併症合併症について解約処分とは,解約処分である.早期の截肢は早期の截肢である.遅刻した截肢.下肢に重度の怪我をすることがあります.

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