一级创伤中心的急诊可手术创伤性肺损伤:回顾性描述研究

IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Military Medicine Pub Date : 2025-02-27 DOI:10.1093/milmed/usae417
Lisa Osborne-Smith, Barry Swerdlow
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引用次数: 0

摘要

简介:尽管使用了防弹衣,紧急可手术肺创伤(EOPT)仍然是战场上发病和死亡的主要原因。虽然军事冲突中的 EOPT 与民用环境中的 EOPT 有一些不同之处,但这两种情况在表现形式、管理和结果方面的研究结果总体上是一致的。本研究的目的是对一级创伤中心 EOPT 的性质及其管理进行描述性分析,并确定 EOPT 患者人口统计学特征和/或患者管理与预后之间的关联,以便更好地了解战场 EOPT:这是一项对一级创伤中心最近 9 年(2012-2020 年)EOPT 进行的回顾性、描述性分析。研究人员搜索了俄勒冈健康与科学大学创伤登记处,106 名患者符合研究的纳入标准。排除了原发性心脏创伤患者。研究人员查阅了个人电子病历以获得描述性数据,并对相关性进行了统计学意义评估:结果:该队列的院内死亡率为 17.0%。EOPT最常见的肺损伤是单侧膈肌撕裂伤(62.3%),EOPT最常见的单次手术是开腹手术(71.7%),通常涉及膈肌修复。在其余的 EOPT 患者中,有 11.3% 的患者进行了开胸手术,有 10.4% 的患者进行了开胸和开腹手术,还有 6.6% 的患者进行了其他手术。EOPT 手术的主要适应症是出血无法控制,三分之一的患者接受了大量输血。单肺通气(OLV)很少使用(8.5%)。在使用单肺通气时,同样可能使用插入主支气管的单腔气管插管(SLETT)、带有支气管阻断器的单腔气管插管或双腔气管插管。从 EOPT 到到达手术室的时间与院内死亡率成反比。此外,在所研究的人群中,最初的院内气管插管和低损伤严重程度评分与存活率密切相关:结论:EOPT手术最常见的适应症是无法控制的大出血。结论:EOPT 最常见的手术指征是无法控制的大出血,EOPT 患者中最常进行的手术是开腹进行膈肌修复。91.5%的EOPT手术没有进行OLV,这是一个意想不到的发现。当发生 OLV 时,同样可能涉及插入主支气管的 SLETT、插入支气管阻断器的 SLETT 或双腔气管导管。OLV 最常见的适应症是手术暴露。更广泛的损伤(以损伤严重程度评分表示)、入院前气管插管以及从 EOPT 到到达手术室的时间更短与死亡率的几率比增加有关。更好地了解民用一级创伤中心 EOPT 的性质有助于确定在战场条件下与更有利的 EOPT 结果相关的条件,从而有助于管理决策,并帮助预后和分流该环境中的重伤患者。
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Emergency Operable Traumatic Pulmonary Injury at a Level 1 Trauma Center: A Retrospective Descriptive Study.

Introduction: Despite the use of body armor, emergency operable pulmonary trauma (EOPT) remains a major cause of battlefield morbidity and mortality. While EOPT during military conflicts has some features that distinguish it from EOPT in civilian settings, the 2 occurrences demonstrate overall parallel findings related to presentation, management, and outcome. The goals of the present study were to provide a descriptive analysis of the nature of EOPT and its management at a level 1 trauma center and to determine the associations between EOPT patient demographics and/or patient management and outcome in order to better understand battlefield EOPT.

Materials and methods: This is a retrospective, descriptive analysis of EOPT at a level 1 trauma center during a recent 9-year period (2012-2020). The Oregon Health & Science University Trauma Registry was searched, and 106 patients met inclusion criteria for the study. Patients with primary cardiac trauma were excluded. Individual electronic medical records were reviewed to obtain descriptive data, and associations were evaluated for statistical significance.

Results: In-hospital mortality in this cohort was 17.0%. The most common pulmonary injury associated with EOPT was unilateral diaphragmatic laceration (62.3%), and the most common single operation performed for EOPT was a laparotomy (71.7%) often involving diaphragmatic repair. In the remaining instances of EOPT, a thoracotomy (11.3%), a thoracotomy and a laparotomy (10.4%), or another surgery (6.6%) occurred. The primary indication for EOPT surgery was uncontrolled hemorrhage, and one-third of patients received massive transfusion. One-lung ventilation (OLV) was infrequently employed (8.5%). When OLV was used, it was equally likely to involve a single-lumen endotracheal tube (SLETT) with mainstem bronchus insertion, a SLETT with a bronchial blocker, or a double-lumen endotracheal tube. Time from EOPT to operating room arrival was inversely related to in-hospital mortality. Also, both initial in-hospital endotracheal intubation and low injury severity score were strongly associated with survival in the population studied.

Conclusions: The most common indication for EOPT surgery was uncontrolled hemorrhage. The most frequent operation performed for this EOPT cohort was a laparotomy for diaphragmatic repair. A total of 91.5% of EOPT surgery was performed without OLV, an unexpected finding. When OLV occurred, it was equally likely to involve an SLETT with mainstem bronchus insertion, an SLETT with bronchial blocker, or a double-lumen endotracheal tube. The most common indication for OLV was surgical exposure. More extensive injury (expressed as an injury severity score), preadmission endotracheal intubation, and a shorter time from EOPT to operating room arrival were associated with increased odds ratios for mortality. A better understanding of the nature of EOPT at a civilian level 1 trauma center can serve to identify conditions that are associated with more favorable outcomes for EOPT under battlefield conditions and thereby assist in both management decisions and to help prognosticate and triage severely injured patients in that setting.

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来源期刊
Military Medicine
Military Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
2.20
自引率
8.30%
发文量
393
审稿时长
4-8 weeks
期刊介绍: Military Medicine is the official international journal of AMSUS. Articles published in the journal are peer-reviewed scientific papers, case reports, and editorials. The journal also publishes letters to the editor. The objective of the journal is to promote awareness of federal medicine by providing a forum for responsible discussion of common ideas and problems relevant to federal healthcare. Its mission is: To increase healthcare education by providing scientific and other information to its readers; to facilitate communication; and to offer a prestige publication for members’ writings.
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