Asensio Juan A, Petrone Patrizio, Roldán Gustavo, Kuncir Eric, Rowe Vincent L, Chan Linda, Shoemaker William, Berne Thomas V
Department of Surgery, Division of Trauma and Critical Care, Los Angeles County, and University of Southern California Medical Center, Los Angeles 90033, USA.
Arch Surg. 2003 Nov;138(11):1187-93; discussion 1193-4. doi: 10.1001/archsurg.138.11.1187.
Iliac vascular injuries incur high mortality.
Retrospective 100-month study (January 1, 1992, through April 30, 2000).
One hundred forty-eight patients with 185 iliac vessel injuries.
Survival and mortality, analyzed by univariate and logistic regression.
Admission mean +/- SD systolic blood pressure was 81 +/- 42 mm Hg, mean Revised Trauma Score was 6.0 +/- 2.8, and mean Injury Severity Score was 20.0 +/- 9.5. The mechanism of injury was penetrating in 140 patients (95%) and blunt in 8 (5%). The mean estimated blood loss was 6246 +/- 6174 mL. Of the 185 injured vessels, 71 (99%) of 72 iliac arteries were repaired, 101 (89%) of 113 iliac veins were ligated, and 12 (11%) of 113 iliac veins were repaired. Overall survival was 51% (76/148). Mortality was 82% (49/72) in patients with exsanguination. Survival by vessel: iliac artery, 57% (20/35); iliac vein, 55% (42/76); and iliac artery and vein, 38% (14/37). Significant predictors of outcome were thoracotomy in the emergency department, associated aortic injury, inferior vena cava injuries, iliac artery and vein injury, intraoperative arrhythmia, and intraoperative coagulopathy. On logistic regression, independent risk factors for survival were absence of thoracotomy in the emergency department, surgical management, and arrhythmia. Mortality by grade on the Organ Injury Scale of the American Association for the Surgery of Trauma (AAST-OIS) was as follows: grade III, 35% (33/95); grade IV, 71% (24/34); and grade V, 79% (15/19).
Mortality remains high. Associated vessel injuries and intraoperative complications predict mortality. AAST-OIS grade for abdominal vascular injuries correlates well with mortality.
髂血管损伤导致的死亡率很高。
回顾性100个月的研究（1992年1月1日至2000年4月30日）。
148例患者共发生185处髂血管损伤。
生存和死亡率，采用单因素分析和逻辑回归分析。
入院时平均收缩压±标准差为81±42 mmHg，平均修正创伤评分6.0±2.8，平均损伤严重度评分20.0±9.5。损伤机制为穿透伤140例（95%），钝性伤8例（5%）。估计平均失血量为6246±6174 mL。在185处损伤血管中，72处髂动脉中的71处（99%）进行了修复，113处髂静脉中的101处（89%）进行了结扎，113处髂静脉中的12处（11%）进行了修复。总体生存率为51%（76/148）。失血性患者的死亡率为82%（49/72）。按血管分类的生存率：髂动脉，57%（20/35）；髂静脉，55%（42/76）；髂动脉和静脉，38%（14/37）。结果的显著预测因素为急诊科开胸手术、合并主动脉损伤、下腔静脉损伤、髂动脉和静脉损伤、术中心律失常及术中凝血功能障碍。逻辑回归分析显示，生存的独立危险因素为非急诊科开胸手术、手术治疗及心律失常。根据美国创伤外科学会（AAST - OIS）器官损伤分级的死亡率如下：III级，35%（33/95）；IV级，71%（24/34）；V级，79%（15/19）。
死亡率仍然很高。合并血管损伤及术中并发症可预测死亡率。腹部血管损伤的AAST - OIS分级与死亡率密切相关。
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