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不同但平等:创伤拉皮切除术后长期停留在麻醉后护理单位的结果
Aubrey E Schachter1, Saskya Byerly1, Caroline Dong1
1Department of Surgery, University of Tennessee Health Sciences Center, Memphis, Tennessee.
The Journal of surgical research
|April 25, 2024
概括
经过损伤控制腹腔切除术与临时腹部关闭 (DCL-TAC) 的创伤患者的麻醉后护理单位 (PACU) 住宿是安全的. 这一发现表明,在没有ICU床位的情况下,PACU可以作为重症监护病房 (ICU) 的替代方案.
科学领域:
- 创伤外科 手术 创伤外科
- 关键护理医学 关键护理医学
- 外科手术的结果
背景情况:
- 医院过度拥挤经常导致重症监护室 (ICU) 的入院延迟,增加病发率和死亡率.
- 有限的数据存在于延迟ICU入院的结果,特别是在术后创伤队列.
- 损伤控制腹腔切除术与临时腹部关闭 (DCL-TAC) 需要早期复苏,通常在ICU.
研究的目的:
- 调查DCL-TAC患者的初始麻醉后护理单位 (PACU) 逗留与与直接ICU入院相比更糟糕的结果有关.
- 评估PACU的安全性和有效性,作为创伤患者的替代重症监护环境.
主要方法:
- 在一级创伤中心五年内接受DCL-TAC的创伤患者的回顾性图表审查.
- 根据指数腹腔切除术后的位置对患者进行分层 (PACU与ICU).
- 采集人口统计数据,伤害数据,复苏标记,并使用多变量逻辑回归比较复合发病率和死亡率结果.
主要成果:
- 在561名DCL-TAC患者中,134名 (24%) 由于ICU床位短缺而停留在PACU;427名 (76%) 直接进入ICU.
- 在PACU和ICU组之间没有观察到人口统计,受伤严重程度,复苏时间,并发症或死亡率的显著差异.
- 在24小时内低度复苏,增加年龄和较高的伤害严重程度得分独立地与死亡率有关.
结论:
- 对于接受损伤控制腹腔切除术与临时腹部关闭 (DCL-TAC) 的患者,进入麻醉后护理单位 (PACU) 并没有不良结果.
- 在ICU床位有限的情况下,PACU可以作为ICU的合适替代方案来进行复苏.
- 这项研究支持对严重受伤的创伤患者灵活利用PACU资源.
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