Sheppard Forest R, Cothren C Clay, Moore Ernest E, Orfanakis Andrea, Ciesla David J, Johnson Jeffrey L, Burch Jon M
Department of Surgery, Denver Health Medical Center, Denver, CO 80204, USA.
Surgery. 2006 Apr;139(4):574-6. doi: 10.1016/j.surg.2005.12.005.
Resuscitative thoracotomy performed in the emergency department (EDT) continues to have clear indications in patients sustaining trauma to the torso, particularly penetrating injuries. However, adjunctive use of aortic cross-clamping during EDT for hemorrhagic shock also may be useful in the acute resuscitation of patient with nontorso injuries (NTI). We questioned the utility of EDT in patients with nontorso trauma.
Patients undergoing EDT have been prospectively followed since 1977 at our regional level I trauma center.
During the 26-year study period, 959 patients underwent EDT; 27 (3%) of these patients underwent EDT for penetrating NTI. Three (11%) of these patients survived to leave the hospital, with only 1 patient sustaining mild neurologic deficit. The mechanism of injury in the survivors was stab wound to the neck (1), gunshot wound to the neck (1), and extremity vascular injury (1). All survivors of EDT for NTI underwent prehospital cardiopulmonary resuscitation and successful endotracheal intubation in the field. There were no survivors of EDT for penetrating injury to the head.
Resuscitative EDT with aortic cross-clamping is a potential adjunct in the acute resuscitation of NTI involving penetrating neck or extremity vascular injuries.
在急诊科进行的复苏性开胸手术（EDT）对于躯干创伤患者，尤其是穿透伤患者，仍有明确的适应症。然而，在EDT期间对失血性休克患者辅助使用主动脉交叉钳夹术，对于非躯干损伤（NTI）患者的急性复苏也可能有用。我们对EDT在非躯干创伤患者中的效用提出质疑。
自1977年以来，我们在地区一级创伤中心对接受EDT的患者进行了前瞻性随访。
在26年的研究期间，959例患者接受了EDT；其中27例（3%）患者因穿透性NTI接受EDT。这些患者中有3例（11%）存活出院，仅1例患者有轻度神经功能缺损。幸存者的损伤机制为颈部刺伤（1例）、颈部枪伤（1例）和肢体血管损伤（1例）。所有接受EDT治疗的NTI幸存者均接受了院前心肺复苏，并在现场成功进行了气管插管。头部穿透伤患者接受EDT后无幸存者。
采用主动脉交叉钳夹术的复苏性EDT是对涉及穿透性颈部或肢体血管损伤的NTI进行急性复苏的一种潜在辅助手段。
