Grove Christopher A, Lemmon Gary, Anderson Gary, McCarthy Mary
Wright State University School of Medicine, Dayton, Ohio 45409, USA.
Am Surg. 2002 Apr;68(4):313-6; discussion 316-7.
The objective of this study was to evaluate the use of emergency thoracotomy in our institution in an effort to determine whether this procedure is both beneficial and cost effective in blunt and/or penetrating trauma. We conducted a retrospective review of charts and coroner's reports. Our setting was a Level I trauma center in a tertiary-care facility. We examined the cases of trauma patients presenting to the trauma center over a 2-year period. Of 2490 patients who presented to the emergency department over the study period 41 underwent early thoracotomy. Twelve of these were excluded from the study because their cases were not truly emergent. Of the remaining 29 ten were admitted for penetrating injuries and 19 for blunt injuries. The average Injury Severity Scores for penetrating and blunt injuries were 30 and 40 respectively. There were four blunt trauma patients who died in the emergency department, 15 went to the operating room, and five who survived to go to the intensive care unit. All blunt trauma patients requiring emergency thoracotomy died within 9 days of presentation. Of the ten penetrating wound patients two died in the emergency department, four died in the operating room, and four went to the intensive care unit after surgery. One of the four patients who went to the intensive care unit died approximately 6 days after injury. The other three patients survived and are now living normal productive lives. All survivors of penetrating trauma who required emergency thoracotomy had their procedure performed in the operating room. Overall survival rates for penetrating and blunt trauma were 30 and 0 per cent respectively. Pericardial tamponade was found in 50 per cent of the penetrating trauma patients (two of the three survivors) and four of 19 of the blunt trauma patients. This reinforces the importance of a prompt pericardiotomy upon opening the chest. At our institution the algorithm for emergency thoracotomy is liberal and is not cost effective for blunt trauma. We need to re-evaluate our decision-making process concerning the use of emergency thoracotomy especially in the blunt trauma patient. The review also shows the importance of pericardiotomy when performing an emergency thoracotomy.
本研究的目的是评估我院急诊开胸手术的应用情况，以确定该手术在钝性和/或穿透性创伤中是否既有益又具有成本效益。我们对病历和验尸官报告进行了回顾性分析。我们的研究地点是一家三级护理机构中的一级创伤中心。我们检查了在两年期间到创伤中心就诊的创伤患者病例。在研究期间到急诊科就诊的2490例患者中，41例接受了早期开胸手术。其中12例被排除在研究之外，因为他们的病例并非真正紧急。在其余的29例中，10例因穿透伤入院，19例因钝性伤入院。穿透伤和钝性伤的平均损伤严重度评分分别为30分和40分。有4例钝性创伤患者在急诊科死亡，15例进入手术室，5例存活并进入重症监护病房。所有需要急诊开胸手术的钝性创伤患者在就诊后9天内死亡。在10例穿透伤患者中，2例在急诊科死亡，4例在手术室死亡，4例术后进入重症监护病房。进入重症监护病房的4例患者中有1例在受伤后约6天死亡。其他3例患者存活，现在过着正常的有意义的生活。所有需要急诊开胸手术的穿透性创伤幸存者均在手术室进行了手术。穿透伤和钝性伤的总体生存率分别为30%和0%。50%的穿透性创伤患者（三名幸存者中的两名）以及19例钝性创伤患者中的4例发现有心包填塞。这强化了开胸时及时进行心包切开术的重要性。在我们机构，急诊开胸手术的算法较为宽松，对钝性创伤而言不具有成本效益。我们需要重新评估我们在急诊开胸手术使用方面的决策过程，尤其是在钝性创伤患者中。该回顾还显示了进行急诊开胸手术时心包切开术的重要性。
