孤立的严重的形脏损伤的结果
Wei Huang1,2, Caitlyn Braschi1, Feifei Jin2
1Division of Trauma and Acute Care Surgery, Department of Surgery, Los Angeles General Medical Center, Los Angeles, California.
JAMA network open
|September 23, 2025
概括
无手术治疗,包括骨血管栓塞 (SAE) 和观察,与骨损伤的开放切除术 (OS) 相比,与较低的发病率和类似的死亡率有关. 仔细选择患者是成功挽救脏的关键.
科学领域:
- 创伤外科 手术 创伤外科
- 外科手术的结果
- 紧急医疗 紧急医疗
背景情况:
- 形脏损伤的管理正在转向脏救援的非手术策略.
- 脊髓血管栓塞 (SAE) 越来越多地被考虑,即使是在低血压患者中.
- 这些不断变化的策略的结果需要进一步调查.
研究的目的:
- 为了比较三种主要治疗方法对严重的形脏损伤的结果.
- 评估不同管理策略的死亡率和并发症率.
主要方法:
- 使用美国外科医生学院创伤质量改善计划 (ACS-TQIP) 数据库 (2017-2022) 的回顾性队列研究.
- 包括单独,严重的形脏损伤的成年人 (缩写损伤量表得分≥3).
- 对比开放的脊髓切除术 (OS),脊髓血管栓塞 (SAE) 和使用多变量考克斯回归的观察.
主要成果:
- 在OS,SAE和观察组中没有观察到死亡率的显著差异.
- 与OS相比,SAE和观察组的发病率明显较低.
- 在低血压患者中,SAE和观察没有显示出死亡率差异,但住院时间较短.
- 非手术管理 (SAE或观察) 的失败导致较高的发病率和较长的住院时间,而不是最初的OS.
结论:
- 非手术管理 (SAE或观察) 与孤立的严重形骨损伤的良好结果有关,即使在低血压患者中也是如此.
- 通过非手术方法挽救脏可能会在经过仔细的患者选择后被优先考虑.
- 非手术治疗的失败会增加发病率,而不会增加死亡率.
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