孤立和非孤立的骨盆骨折中的出血性休克:基于注册的研究
Amir Gottfried1, Sami Gendler1, David Chayen1,2
1Israel Defense Forces Medical Corps, Surgeon's General Headquarters, Ramat Gan, Israel.
Prehospital emergency care
|February 28, 2024
概括
孤立的骨盆骨折很少在创伤患者中引起深刻的休克. 相关的伤害显著增加了出血性休克和死亡的风险,需要迅速处理这些严重的伤害.
科学领域:
- 创伤外科 手术 创伤外科
- 紧急医疗 紧急医疗
- 骨科创伤的创伤是什么
背景情况:
- 高能量的骨盆骨折往往导致血液动力学不稳定性和高死亡率.
- 由于频繁的相关伤害,盆腔脱血对出血性休克的贡献是不确定的.
- 这项研究区分了孤立和非孤立的骨盆骨折之间的结果.
研究的目的:
- 为了比较患有孤立骨盆骨折与非孤立骨盆骨折的患者出血性休克的发生率.
- 根据骨盆骨折隔离来评估住院结果,包括死亡率.
主要方法:
- 一项基于注册的研究利用了1997-2021年的数据,交叉引用了以色列国防军创伤注册表和以色列国家创伤注册表.
- 患有孤立骨盆骨折的患者在其他地区的缩略伤害量表 (AIS) 得分为<3.
- 深度休克被定义为静脉血压<90 mmHg和/或心率>130 bpm在急诊室 (ED) 抵达时.
主要成果:
- 分析了244名骨盆骨折患者;27.9%的人有孤立骨折.
- 在ED到来时出血性休克发生在20.5%的患者中,主要是那些有非孤立骨折的患者 (只有4个孤立病例).
- 所有18例住院死亡病例 (7.4%) 都发生在患有非隔离骨盆骨折的患者中,经常伴有胸部或腹部损伤.
结论:
- 在年轻的创伤患者中,孤立的骨盆骨折很少出现深度休克.
- 严重的相关损伤在非孤立的骨盆骨折中很常见,并且与更高的冲击发病率和死亡率有关.
- 预科医院协议应强调快速疏散和复苏,以解决骨盆骨折患者的相关损伤.
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