时间问题:多次肋骨骨折和肺伤患者的早期或晚期肋骨固定
Emanuele Lagazzi1, Wardah Rafaqat2, Dias Argandykov2
1Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, MA; Department of Surgery, Humanitas Research Hospital, Rozzano, MI, Italy. Electronic address: https://twitter.com/EmanueleLagazzi.
Surgery
|January 3, 2024
概括
肋骨骨折的早期手术稳定有利于肺伤患者,减少住院时间和并发症. 这种时间是有利的,无论伤的严重程度如何.
科学领域:
- 创伤外科 手术 创伤外科
- 胸部外科手术 胸部外科手术
- 关键护理医学 关键护理医学
背景情况:
- 已知手术稳定肋骨骨折 (SSRF) 对肺伤患者有好处.
- 在这个患者群体中SSRF的最佳时间仍在研究中.
研究的目的:
- 为了比较早期 (<72小时) 与晚期 (≥72小时) 肋骨骨折手术稳定成年患者的结局,这些患者有创伤性肋骨骨折和同时发生的肺伤.
主要方法:
- 从2016-2020年美国外科医生学院创伤质量改善计划中对2839名成年患者进行了回顾性分析.
- 倾向性得分匹配被用来创建1,096个平衡的对,比较早期与晚期的SSRF.
- 结果包括住院时间长,ARDS,计划外输管,呼吸机日,ICU入院,ICU住院时间长,气管切除术和死亡率.
主要成果:
- 早期的SSRF与住院时间 (9 vs 13天) 和ICU住院时间 (5 vs 7天) 显著缩短.
- 接受早期SSRF的患者有较低的无计划输管率 (7.4%vs11.4%),无计划的ICU入院 (4.2%vs10.5%),和气管切除术 (8.4%vs12.4%).
- 这些好处在患有重大或轻微肺伤的子组中一致.
结论:
- 肋骨骨折的早期手术稳定 (<72小时) 与改善患者结局有关.
- 手术稳定时间似乎是管理肺伤肋骨骨折的关键因素.
- 早期干预可能是有益的,无论肺的严重程度.
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