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实施300毫升规则的创伤性血胸管理
Abdul Hafiz Al Tannir1, Elise A Biesboer, Morgan Tentis
1From the Division of Trauma and Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.
Journal of the American College of Surgeons
|June 4, 2024
概括
在稳定的患者中,实施创伤性血胸 (HTX) 减少管胸切除术 (TT) 使用的300毫升指南. 这种变化降低了TT的位置,但没有增加观察失败或并发症.
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:
- 创伤性血胸 (HTX) 管理通常涉及管胸切除术 (TT),其并发症率很高.
- 一个I级创伤中心实施了一项指导方针,以观察血液动力稳定的患者的HTX≤300毫升.
- 该研究假设这一指导方针将减少TT的使用,而不会增加观察失败.
研究的目的:
- 评估一个新的指南对管理创伤性血胸 (HTX) 的影响.
- 为了确定在稳定的患者中观察HTX≤300mL是否会减少管胸切除术 (TT) 的放置.
- 评估指南实施后观察失败率和并发症率的变化.
主要方法:
- 在指南实施之前 (2015-2016) 和之后 (2018-2019) 的CT扫描上对HTX成年患者的单中心回顾性审查.
- 排除标准包括CT前的TT,没有CT,早期死亡和显著的并发性肺胸部.
- 使用CT和Mergo的公式计算HTX体积;主要结果是观测失败.
主要成果:
- 357名患者符合标准,210名患者属于实施后队列.
- 观察率显著增加 (75%对59%),而TT安置率下降 (42%对57%).
- 实施后组的住院和ICU停留时间较短;观察失败或并发症没有显著差异.
结论:
- 对创伤性血胸部的300毫升指南显著减少了管胸切除术 (TT) 的放置.
- 准则的实施并没有增加观测失败率.
- 在指南后,没有发现肺部并发症,再入院或死亡率的增加.
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