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严重腹部创伤后患者报告的结果:对损害控制拉皮切除试验的二次分析

Shah-Jahan M Dodwad¹, Kayla D Isbell¹, Krislynn M Mueck²

¹Department of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas; Center for Surgical Trials and Evidence-based Practice, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas.

The Journal of surgical research

|September 16, 2023

概括

在腹部创伤后,患者报告的结果显示,无论手术方法如何,功能缺陷仍然存在. 在这项研究中,绝对腹腔切除术 (DEF) 没有显示出比损伤控制腹腔切除术 (DCL) 更好的结果.

科学领域:

创伤外科手术创伤外科
外科手术的结果
患者报告的结果

背景情况:

在腹部创伤后,患者报告的结果 (PROs) 尚不清楚.
手术管理策略,包括最终腹腔切除术 (DEF) 和损伤控制腹腔切除术 (DCL),可能会影响长期康复.
假设:与DCL相比,DEF会导致更高的PRO.

研究的目的:

在患有腹部创伤的患者中,比较最终腹腔切除术 (DEF) 和损伤控制腹腔切除术 (DCL) 之间的患者报告结果.
评估生命质量和创伤后应激障碍症状在出院时和手术后六个月.

主要方法:

在DCL试验中,患者被随机分为DEF或DCL.
使用欧洲生活质量-5维-5级 (EQ-5D) 和创伤后应激障碍 (PTSD) 检查清单-平民来衡量PRO.
贝叶斯分析评估了实现最小临床重要差异的概率.

主要成果:

在39名随机选择的患者中,有8人死亡 (7名DEF与1名DCL).
释放时的EQ-5D分数 (DEF:0.20与DCL:0.31) 和六个月 (DEF:0.51与DCL:0.50) 没有显示出有利于DEF的显著差异.
实现最小临床重要差异的概率在出院时为16%,在六个月后为23%,有利于DCL.

结论:

在创伤患者中,无论使用的腹腔切除术策略如何,功能缺陷仍然存在.
长度研究是必要的,以提供准确的恢复期望,为患者经历腹部创伤手术.
目前的数据不支持DEF产生的PRO比DCL更好.

关键词:

腹部创伤腹部创伤损害控制腹腔切除术腹腔切除术患者报告的结果.生活质量生活的质量.创伤性腹腔切除术 (Laparotomy) 是一个创伤性腹腔切除术.

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