肾上腺创伤与高损伤严重程度和死亡率相关。

Adrenal gland trauma is associated with high injury severity and mortality.

作者信息

Stawicki Stanislaw P, Hoey Brian A, Grossman Michael D, Anderson Harry L, Reed James F

机构信息

Department of Surgery, St. Lukes Hospital and Health Network, Bethlehem, Pennsylvania 18015, USA.

出版信息

Curr Surg. 2003 Jul-Aug;60(4):431-6. doi: 10.1016/S0149-7944(02)00796-1.

DOI:10.1016/S0149-7944(02)00796-1

PMID:14972236

Abstract

PURPOSE

To review a statewide experience of adrenal gland trauma (AGT), incidence, demographics, associated injuries, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), mechanisms of injury, and complications, associated with AGT.

METHODS

A retrospective analysis of patients admitted to accredited trauma centers in the Commonwealth of Pennsylvania who sustained AGT from January 1, 1989 to December 31, 2000.

RESULTS

Adrenal trauma was found in 322 of 210,508 cases (0.15%). There were 76.4% men and 23.6% women. Seventy-one percent of patients had an ISS greater than 20. The overall mortality was 32.6%. The mechanism of injury was blunt in 81.4% of the cases and penetrating in 18.6%. Vehicular accidents constituted 48.8% of the cases. Younger age was associated with male predominance and greater proportion of penetrating injuries. Although exact indications are not known, advanced imaging studies were done in 163 of 322 (50.6%) patients: computed tomography in 133 (41.3%), ultrasound in 26 (8.1%), and angiography in 4 cases (1.2%). Exploratory laparotomy was done in 60 (18.6%), splenectomy in 25 (7.8%), nephrectomy in 14 (4.3%), and adrenalectomy in 8 (2.5%). Penetrating injuries had a 43.8% rate of exploratory laparotomy, whereas it was 12.4% in blunt trauma. Associated injuries included liver injury (57.8%), rib fractures (50.9%), kidney injury (41.3%), and spleen injury (32.9%). Pulmonary complications were most common, followed by infection/sepsis, and cardiovascular. Nearly 45% of patients were discharged home, 17% of patients were discharged to a rehabilitation facility, and 3.4% to nursing homes.

CONCLUSIONS

Adrenal gland trauma is a rare and largely coincidental finding diagnosed either during an initial radiologic examination or surgical exploration for other injuries. Surgical exploration was carried out in 21.4% of patients, with adrenalectomy in 2.5% of cases and nephrectomy in 4.3% of cases. Adrenal injury is associated with high injury severity, and with mortality rates up to 5 times higher than non-AGT trauma.

摘要

目的

回顾宾夕法尼亚州肾上腺损伤（AGT）的全州经验，包括发病率、人口统计学特征、相关损伤、损伤严重度评分（ISS）、格拉斯哥昏迷量表（GCS）、损伤机制及并发症。

方法

对1989年1月1日至2000年12月31日期间入住宾夕法尼亚州认可创伤中心且发生AGT的患者进行回顾性分析。

结果

在210,508例病例中有322例发现肾上腺损伤（0.15%）。男性占76.4%，女性占23.6%。71%的患者ISS大于20。总体死亡率为32.6%。81.4%的病例损伤机制为钝性伤，18.6%为穿透伤。车祸占病例的48.8%。年轻患者以男性为主且穿透伤比例更高。尽管确切指征不明，但322例患者中有163例（50.6%）进行了高级影像学检查：133例（41.3%）行计算机断层扫描，26例（8.1%）行超声检查，4例（1.2%）行血管造影。60例（18.6%）进行了剖腹探查，25例（7.8%）行脾切除术，14例（4.3%）行肾切除术，8例（2.5%）行肾上腺切除术。穿透伤的剖腹探查率为43.8%，钝性伤为12.4%。相关损伤包括肝损伤（57.8%）、肋骨骨折（50.9%）、肾损伤（41.3%）和脾损伤（32.9%）。肺部并发症最常见，其次是感染/脓毒症和心血管并发症。近45%的患者出院回家，17%的患者出院后前往康复机构，3.4%前往疗养院。