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伤害控制胸切除术趋势,技术和结果:一个EAST多中心试验
Anthony D Douglas1, Teddy Puzio, Partick Murphy
1From the Department of Surgery (A.D.D., N.B., J.Finch., H.S., M.J.L.), Indiana University School of Medicine, Indianapolis, Indiana; Department of Surgery (T.Puzio), University of Texas Houston, Houston, Texas; Department of Surgery (P.M., J.Figueroa), Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Surgery (J.N., D.C.), University of California Irvine, Irvine, California; Department of Surgery (H.K., A.G.), Massachusetts General Hospital, Boston, Massachusetts; Department of Surgery (L.T.), Northwestern Medical Center, Chicago, Illinois; Department of Surgery (B.R.), University of Washington, Seattle, Washington; Department of Surgery (M.C.), Envision Physician Services Dallas LLC, Dallas, Texas; Department of Surgery (L.H., R.K.), University of Chicago Medicine, Chicago, Illinois; Department of Surgery (A.S.), University of Washington School of Medicine, Seattle, Washington; Department of Surgery (D.T.), Mayo Clinic College of Medicine and Science, Rochester, Wisconsin; Department of Surgery (G.W.), University Illinois Chicago, Chicago, Illinois; Department of Surgery (G.Capron), Cook County Health, Chicago, Illinois; Department of Surgery (A.V., B.B., A.K.), Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas; Department of Surgery (A.L.), Albert Einstein Medical Center, New York, New York; Department of Surgery (J.T., D.C.), University of Liverpool School of Medicine, Liverpool, UK; Department of Surgery (A.G.-S., T.Powers), Cooper Medical School of Rowan University, Camden, New Jersey; Department of Surgery (A.R., S.S.), Crozer Chester Medical Center, Upland, California; Department of Surgery (F.M., G.-I.P.), University General Hospital of Patras, Rio, Greece; Department of Surgery (J.R.), Hospital Dr. Sotero del Rio, Santiago de Chile, Chile; Department of Surgery (L.V.), Loma Linda University, Loma Linda, California; Department of Surgery (N.F.), Texas Health Harris Methodist Hospital, Fort Worth, Texas; Department of Surgery (L.F., R.M.), The University of Tennessee at Chattanooga, Chattanooga, Tennessee; Department of Surgery (C.S., K.S.), Grant Medical Center, Columbus, Ohio; Department of Surgery (L.S.), Alameda County Medical Center, Oakland, California; Department of Surgery (R.B.), Spartanburg Regional Medical Center, Spartanburg, South Carolina; Department of Surgery (S.D.), University of Kentucky College of Medicine, Lexington, Lexington; Department of Surgery (G.H., C.C.), University of California Davis Medical Center, Sacramento, California; Department of Surgery (G.Chang), University of Illinois Chicago, Chicago, Illinois; and Department of Surgery (A.D.M.), Indiana University Health, Indianapolis, Indianapolis, IN.
损伤控制胸切除术 (DCT) 的使用正在增加,显示了更多的重症监护室 (ICU) 免费日,但死亡率没有变化. 临时关闭的方法应该与外科医生的专业知识和可用的资源保持一致.
科学领域:
- 创伤外科 手术 创伤外科
- 手术重症监护手术重症监护
- 胸部外科手术 胸部外科手术
背景情况:
- 损害控制胸切除术 (DCT) 关于频率,技术和结果的证据有限.
- 这项研究解决了关于DCT利用和相关结果的缺乏数据的问题.
研究的目的:
- 为了检查10年来DCT使用趋势.
- 在DCT中评估临时关闭技术.
- 评估与DCT相关的结果和并发症.
主要方法:
- 25个中心的国际回顾性队列研究 (2008-2020年)
- 包括16岁以上的患者,在入院24小时内接受胸切除术,在ICU幸存下来.
- 用混合物流回归和竞争风险回归进行分析.
主要成果:
- 在922例胸切除术中,有402例 (44%) 是DCT,主要是穿透性损伤 (66%).
- 常见的临时关闭:商业真空装置 (30%) 和粘合剂 (32%).
- DCT组的死亡率 (61%对17%) 和并发症 (肺炎,急性功能衰竭,败血症) 较高.
结论:
- 连续治疗的利用率正在增加,无ICU日数有所改善,但死亡率没有变化.
- 根据临时关闭类型,并发症没有显著差异.
- 临时关闭的选择应该取决于运营商的经验和机构资源.
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