Granchi T, Schmittling Z, Vasquez J, Schreiber M, Wall M
Department of Surgery, Baylor College of Medicine and Ben Taub General Hospital, Houston, Texas, USA.
Am J Surg. 2000 Dec;180(6):493-6; discussion 496-7. doi: 10.1016/s0002-9610(00)00508-0.
Temporary arterial shunts maintain perfusion while surgeons postpone arterial repairs. The common indications are combined orthopedic and vascular injuries and damage control. The duration of patency and the need for systemic anticoagulation remain in question. We examined our experience for answers.
We searched for patients who had temporary arterial shunts and collected the following: mechanism, artery injured, shunt time, blood loss and transfusions, injury severity score (ISS,) mangled extremity severity score (MESS,) and anticoagulation.
Of 19 patients, 10 had shunts for damage control (group 1,) and 9, for orthopedic/vascular injuries (group 2.) group 1 had significantly higher shunt time, mortality, ISS, and MESS. Shunt time ranged from 47 to 3,130 minutes (52 hours.) Two patients, 1 in each group, required amputations.
Temporary arterial shunts can be use for combined orthopedic and vascular injuries and for damage control. Shunts can stay open for 52 hours without systemic anticoagulation.
在外科医生推迟动脉修复时，临时动脉分流术可维持灌注。常见适应证为合并骨科和血管损伤以及损伤控制。通畅持续时间和全身抗凝需求仍存在疑问。我们通过回顾自身经验寻找答案。
我们查找了接受临时动脉分流术的患者，并收集了以下信息：受伤机制、受伤动脉、分流时间、失血量和输血情况、损伤严重程度评分（ISS）、肢体毁损严重程度评分（MESS）以及抗凝情况。
19例患者中，10例因损伤控制而行分流术（第1组），9例因骨科/血管损伤而行分流术（第2组）。第1组的分流时间、死亡率、ISS和MESS显著更高。分流时间为47至3130分钟（52小时）。两组各有1例患者需要截肢。
临时动脉分流术可用于合并骨科和血管损伤以及损伤控制。分流术可不进行全身抗凝而保持开放52小时。
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