创伤性肺切除术:在过去二十年中,生存率有没有改善?
Seema P Anandalwar1, Amar Deshwar1, Elizabeth Powell1
1Department of Trauma, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA.
The American surgeon
|April 23, 2025
概括
创伤肺切除术护理的近期进展,包括胸部损伤控制和毒性体外膜氧化 (VV-ECMO),显著降低了晚期死亡率. 早期死亡率仍然很高,但改进的管理策略为这些关键患者提供了更好的长期生存的希望.
科学领域:
- 创伤外科 手术 创伤外科
- 支持心肺血管的支持.
- 关键护理医学 关键护理医学
背景情况:
- 创伤性肺切除术是一种危及生命的手术,死亡率历史高.
- 重症监护和手术技术的进步可能会影响这些患者的治疗结果.
- 评估随着时间的推移管理的变化对于理解生存趋势至关重要.
研究的目的:
- 测试改善机械心肺支和手术管理提高了创伤性肺切除术患者的生存率的假设.
- 为了比较两个不同的时间段 (2003-2010年和2011-2023年) 的结果,以确定生存和管理的趋势.
主要方法:
- 在2003年至2023年期间,对20名因创伤而接受肺切除术的患者进行了回顾性单中心研究.
- 收集的数据包括人口统计,生理参数,使用毒性体外膜氧化 (VV-ECMO) 和死亡率 (早期和晚期).
- 结果被分析并比较了第一个 (2003-2010年) 和第二个 (2011-2023年) 十年.
主要成果:
- 虽然伤害严重性评分 (ISS) 和整体/早期死亡率在几十年之间没有显著差异,但在第二个十年中,晚期死亡率急剧下降 (9%与50%相比).
- 第二个十年,胸部损伤控制手术 (100%对33%) 和带有肺休息通风的VV-ECMO (64%对22%) 的使用增加.
- 第二个十年的患者表现出更严重的生理障碍 (pH值较低,基数不足较高),表明在呈现时疾病更为严重.
结论:
- 尽管持续高的早期死亡率,胸部损伤控制手术和早期启动VV-ECMO的结合似乎是显著减少晚期死亡率的关键因素.
- 这些发现表明,现代的重症监护和手术策略改善了需要创伤性肺切除术的患者的长期存活率.
- 对优化这些干预措施的进一步研究是有必要的,以进一步改善这种高风险患者群体的结果.
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