包装胸部:在胸部创伤管理的损害控制策略
Anthony D Douglas1, Thaddeus J Puzio2, Patrick B Murphy3
1Indiana University School of Medicine, Indianapolis, IN, USA.
Injury
|March 24, 2024
概括
损伤控制胸切除术 (DCT) 是严重的胸部创伤的可行选择,尽管死亡率较高. 这种方法与绝对胸切除术 (DT) 相比,提供了类似的ICU住院和呼吸机日.
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:
- 损伤控制手术 (DCS) 旨在稳定严重受伤的患者,以便以后进行最终治疗.
- 有限的数据存在损害控制胸切除术 (DCT) 在创伤,和最佳的临时胸部关闭方法是未知的.
研究的目的:
- 评估创伤患者的损伤控制胸切除术 (DCT) 与最终胸切除术 (DT) 的结果.
- 为了比较患者的特征,生理障碍和DCT和DT之间的结果.
主要方法:
- 在两个I级创伤中心进行胸切除术的76名创伤患者的回顾性评估.
- 排除标准包括24小时后的胸切除术,年龄小于16岁,或在ICU入院前死亡.
- 使用单向ANOVA和克鲁斯卡尔-瓦利斯试验进行统计分析,以比较DCT和DT组之间的变量.
主要成果:
- 在30名患者 (39%) 进行了DCT,而46人 (61%) 接受了DT.
- DCT患者表现出更大的生理障碍 (HR,pH) 和更高的损伤严重程度得分,需要更多的输血.
- 在DCT中,死亡率 (63.3%与5.0%相比),心脏骤停和意外返回OR率显著增加,但ICU停留和通风器日数相似.
结论:
- 损伤控制胸切除术 (DCT) 是严重受伤的胸部创伤患者的可行选择.
- 在DCT中较高的死亡率可能是由于最初的伤害严重程度和生理状态.
- 在DCT中,可比的并发症率,ICU停留时间和通风器天数与绝对胸切除术 (DT) 相似.
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