在多重创伤患者中严重的脏损伤
Wei Huang1,2, Caitlyn Braschi2, Feifei Jin1
1Peking University People's Hospital, Trauma Center, Beijing, China.
对于创伤患者的严重形脏损伤,非手术管理 (NOM) 如脏血管栓塞或观察与较低的死亡率和较少的并发症有关,而不是开放式脏切除术. NOM是安全的,即使对于低血压患者.
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:
- 在多创伤患者中,严重的形脊髓损伤 (BSI) 的最佳管理仍在争论中.
- 这项研究评估了严重BSI的三个主要治疗策略的早期结果.
研究的目的:
- 分析多重创伤患者严重BSI的治疗模式和临床结果.
- 为了比较开放的脊髓切除术 (OS),脊髓血管栓塞 (SAE) 和观察 (OBS) 严重的BSI.
主要方法:
- 一项使用美国外科医生学院创伤质量改善计划数据库 (2017-2022) 的队列研究.
- 分析了严重的BSI和多重创伤的成年患者,但不包括轻微受伤的患者.
- 结果比较包括死亡率,并发症 (ARDS,心脏骤停,败血症) 和停留时间 (LOS),以及低血压和失败的非手术治疗 (NOM) 的子组分析.
主要成果:
- 在12930名患者中,26.2%的患者有OS,19.6%的SAE,54.2%的OBS.
- 与SAE和OBS相比,SAE和OBS与明显较低的死亡率 (HR分别为0.62和0.61) 和较少的并发症有关.
- SAE和OBS组的医院和ICU LOS较短;NOM失败与预先的OS相比增加了并发症.
结论:
- 在严重的BSI多重创伤患者中,脏救援 (SAE和OBS) 与死亡率降低,并发症减少和住院时间缩短有关,而与脏切除术相比.
- 非手术治疗 (NOM) 是一个可行的选择,即使对于低血压患者,也没有增加死亡率或并发症.
- 在多创伤患者中,包括那些呈现低血压的患者中,应考虑对严重的BSI进行NOM.
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