打破协议:在平衡的血液产品复苏时代,破坏性结肠损伤是否应该以不同的方式管理?
Kevin J Lang1, Devanshi D Patel, Meredith R Perkins
1From the Division of Trauma/Surgical Critical Care, Department of Surgery (K.J.L., D.D.P., M.R.P., A.M.F., C.E.J.-S., S.E.B., D.M.F., C.R.E.), University of Tennessee Health Science Center, Memphis, Tennessee; and Department of Surgery (J.P.S.), Covenant HealthCare, Saginaw, Michigan.
The journal of trauma and acute care surgery
|November 19, 2025
概括
通过重新评估当前的协议,可以改善创伤性结肠损伤的管理. 输血量与风险相关,但不与道泄漏相关,这表明需要更新管理这些损伤的指导方针.
科学领域:
- 创伤外科 手术 创伤外科
- 外科手术的结果
- 结肠直肠手术 结肠直肠手术
背景情况:
- 创伤性结肠损伤具有显著的发病率.
- 目前的协议经常建议转移 ostomy 高输血量 (> 6 单位包装红细胞 [pRBCs]) 或并发症.
- 这些基于过时的复苏实践的协议导致了高比例的口腔形成.
研究的目的:
- 重新评估现有的管理创伤性结肠损伤的机构协议.
- 评估结肠损伤患者在没有转移的情况下切除和解剖解剖的结果.
- 为了确定影响静脉漏,,再手术和死亡率的因素.
主要方法:
- 在一级创伤中心5年创伤性结肠损伤的回顾性审查.
- 对未经转移进行切除和解的患者进行分析.
- 评估变量包括24小时pRBC输血,冲击指数,BMI,并发症和胰腺损伤.
主要成果:
- 在213名没有转移治疗的患者中,4.7%的患者经历了静脉漏.
- 协议的遵守与较低的 rate (24% vs. 67%,p=0.010) 和较少的排水位置 (17% vs. 56%,p=0.012) 相关.
- 输血量与 (AOR 1.30) 和胰腺损伤 (AOR 6.03) 相对相关;冲击指数和BMI预测了解静脉泄漏和重新手术.
结论:
- 结肠损伤患者的输血量经历了切除和无转移的解,与的风险相关,但与解漏,重新手术,骨干或死亡率无关.
- 冲击指数和BMI可能会成为解静脉泄漏和重新手术的更好的预测指标.
- 目前的结肠损伤管理方案需要根据现代输血策略和干预放射学进行重新评估.
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