Asensio Juan A, Petrone Patrizio, Roldán Gustavo, Kuncir Eric, Ramicone Emily, Chan Linda
Department of Surgery, Division of Trauma and Critical Care, Los Angeles County and University of Southern California Medical Center, Los Angeles, USA.
Arch Surg. 2004 Feb;139(2):209-14; discussion 215. doi: 10.1001/archsurg.139.2.209.
Awareness of guidelines for damage control can improve patient outcomes after postraumatic open abdomen.
Retrospective (November 1992 to December 1998), prospective (January 1999 to July 2001), 104-month study.
Los Angeles County and University of Southern California Medical Center, Los Angeles.
All patients undergoing damage control resulting in posttraumatic open abdomen.
The main outcome measure was survival. Data were also collected on surgical findings and indications for damage control, including organs injured, intraoperative estimated blood loss, and intraoperative fluids, blood, and blood products administered. Postoperative complications, length of time patients had an open abdomen, and surgical intensive care unit and hospital length of stay were also recorded.
No difference in mortality existed between patients admitted before awareness of guidelines (group 1; 21 [24%] of 86 patients died) and patients who underwent damage control following these suggested guidelines (group 2; 13 [24%] of 53 patients died) (P =.85). Of the 139 patients, 100 had penetrating injuries and 39 had blunt injuries. Estimated blood loss was 4764 +/- 5349 mL. Mean intraoperative fluid replacement was 22 034 mL. One hundred one patients (73%) experienced 228 complications, for a mean of 2.26 complications per patient. Group 1 patients spent a longer time in the operating room (mean, 4.09 +/- 1.99 hours; range, 0.4-9.5 hours) vs group 2 patients (mean, 2.34 +/- 1.50 hours; range, 0.3-6.2 hours; P<.001). The surgical intensive care unit length of stay was 23.5 +/- 18.3 days vs 8.7 +/- 14.9 days (P<.001), and the hospital length of stay was 37.4 +/- 27.5 days vs 12.4 +/- 21.0 days (P<.001) in survivors and nonsurvivors, respectively.
We recommend close monitoring of intraoperative outcome predictors as validated within our guidelines and recommend following our model for early institution of damage control.
对损伤控制指南的认知可改善创伤后开放性腹部损伤患者的预后。
回顾性研究（1992年11月至1998年12月）、前瞻性研究（1999年1月至2001年7月），为期104个月的研究。
洛杉矶县及南加州大学医学中心，洛杉矶。
所有因损伤控制导致创伤后开放性腹部损伤的患者。
主要结局指标为生存率。还收集了手术发现及损伤控制指征的数据，包括受损器官、术中估计失血量以及术中输注的液体、血液和血液制品。记录术后并发症、患者开放性腹部的持续时间以及外科重症监护病房住院时间和医院住院时间。
在指南认知前入院的患者（第1组；86例患者中有21例[24%]死亡）与遵循这些建议指南进行损伤控制的患者（第2组；53例患者中有13例[24%]死亡）之间，死亡率无差异（P = 0.85）。139例患者中，100例为穿透伤，39例为钝挫伤。估计失血量为4764±5349毫升。术中平均液体补充量为22034毫升。101例患者（73%）发生228例并发症，平均每位患者2.26例并发症。第1组患者在手术室的时间更长（平均4.09±1.99小时；范围0.4 - 9.5小时），而第2组患者为（平均2.
