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手术室的时间是否会影响儿科粗空洞粘膜损伤后的结果? 一个创伤质量改善计划分析分析

William R Johnston¹, Allison L Mak Croughan, Rosa Hwang

¹From the Department of General, Thoracic, and Fetal Surgery (W.R.J., A.L.M.C., R.H., M.A., M.L.N., G.N.), Children's Hospital of Philadelphia; and Department of General Surgery (W.R.J.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.

The journal of trauma and acute care surgery

|November 19, 2024

概括

对于儿科粗空洞粘膜损伤 (HVI) 的延迟手术不会增加感染或死亡风险. 虽然注意到更长的住院时间,但对于患有凸空洞粘膜损伤的患者,结果仍然相似.

科学领域:

儿科手术儿科手术
创伤外科手术创伤外科
胃肠道手术胃肠道手术

背景情况:

的空洞粘膜损伤 (HVIs) 不常见,在儿童中难以诊断.
延迟手术干预对儿科突发性HVI结局的影响尚未得到充分证实.

研究的目的:

为了研究延迟手术与儿科患者患有凸空洞粘膜损伤的结果之间的关联.
分析多中心数据,以确定延迟手术干预是否会影响患者的结果.

主要方法:

查询创伤质量改善计划数据库 (2016-2020年) 的儿科患者 (<18岁) 患有需要手术的突发性HVI.
排除有固体器官损伤或其他重大胸部/腹部手术的患者.
根据从急诊部到达手术室的时间 (1-72小时) 和结果分析对患者进行分类.

主要成果:

确定了1,700名患有形HVI的儿科患者;9%的患者经历了延迟的手术 (>24小时).
延迟手术患者的伤害严重性得分较高,住院/ICU时间较长,但手术部位感染,败血症或死亡风险没有增加.
延迟的手术与较少的全厚损伤识别和更多同时发生的骨科损伤有关.

结论:

迟迟的诊断和手术对于的HVI可能会发生,特别是在分散注意力的伤害或没有全厚穿孔的情况下.
尽管受伤情况更严重,住院时间更长,但对于儿科突发性HVI的延迟手术干预似乎并没有恶化关键不良结果.
这表明,在特定的儿科突发性HVI病例中,有潜在的非手术治疗或延迟的手术干预窗口.

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