Edens Jason W, Beekley Alec C, Chung Kevin K, Cox E Darrin, Eastridge Brian J, Holcomb John B, Blackbourne Lorne H
United States Army Institute of Surgical Research, Fort Sam Houston, TX 78234, USA.
J Am Coll Surg. 2009 Aug;209(2):188-97. doi: 10.1016/j.jamcollsurg.2009.03.023.
The incidence, survival, and blood product use after emergency department thoracotomy (EDT) in combat casualties is unknown.
We performed a prospective and retrospective observational study of EDT at a combat support hospital in Iraq, evaluating the impact of injury mechanisms, blood product use, mortality, and longterm neurologic outcomes of survivors.
From November 2003 to December 2007, 12,536 trauma admissions resulted in 101 EDTs (0.01%). In patients undergoing EDT, penetrating trauma from explosions and firearms accounted for the majority of injuries (93%). There were no survivors after EDT for blunt trauma (n=7). The areas of primary penetrating injury were the abdomen (30%), thorax (40%), and extremities (22%). Twelve percent (12 of 101) of all patients survived until evacuation, with the overall survival rate (8 to 26 months) of US casualties at 11% (6 of 53). There was no difference in survival seen in either injury mechanism or primary injury location. Signs of life were present in all overall survivors. Cardiopulmonary resuscitation (CPR) was performed in 92% (93 of 101) of all patients, and in 75% (9 of 12) of those evacuated. Mean (+/-SD) transfusion requirements for all patients were 15.0+/-12.7 U of RBC and 7.3+/-8.7 U of fresh frozen plasma during the initial resuscitation. Survivors demonstrated higher fresh frozen plasma:RBC ratios. All survivors were neurologically intact.
In the combat casualty with penetrating injury, arriving with signs of life, receiving CPR, and undergoing EDT, longterm survival with normal neurologic outcomes is possible. CPR is not a contraindication to performance of EDT in penetrating injuries if signs of life are present. A large amount of blood products are used in the resuscitation of EDT patients.
战斗伤员在急诊科开胸手术（EDT）后的发病率、生存率及血液制品使用情况尚不清楚。
我们在伊拉克一家战斗支援医院对EDT进行了一项前瞻性和回顾性观察研究，评估损伤机制、血液制品使用、死亡率及幸存者的长期神经学结局的影响。
2003年11月至2007年12月，12536例创伤入院患者中有101例行EDT（0.01%）。在接受EDT的患者中，爆炸和火器所致穿透伤占大多数损伤（93%）。钝性创伤患者行EDT后无幸存者（n = 7）。主要穿透伤部位为腹部（30%）、胸部（40%）和四肢（22%）。所有患者中有12%（101例中的12例）存活至后送，美国伤员的总体生存率（8至26个月）为11%（53例中的6例）。损伤机制或主要损伤部位的生存率无差异。所有总体幸存者均有生命体征。所有患者中有92%（101例中的93例）进行了心肺复苏（CPR），后送患者中有75%（12例中的9例）进行了心肺复苏。初始复苏期间，所有患者的平均（±标准差）输血需求量为红细胞15.0±12.7单位和新鲜冰冻血浆7.3±8.7单位。幸存者的新鲜冰冻血浆与红细胞比值更高。所有幸存者神经功能均完好。
对于有穿透伤、有生命体征、接受CPR并接受EDT的战斗伤员，有可能实现长期存活且神经学结局正常。如果有生命体征，CPR并非穿透伤行EDT的禁忌证。EDT患者复苏时使用大量血液制品。
