Pahle Andreas Saxlund, Pedersen Bastian Løe, Skaga Nils Oddvar, Pillgram-Larsen Johan
Department of Cardiothoracic Surgery, Ulleval University Hospital, Oslo, Norway.
J Trauma. 2010 Mar;68(3):599-603. doi: 10.1097/TA.0b013e3181a5ec54.
: Emergency thoracotomy (ET) is a life-saving procedure used to control hemorrhage and relieve cardiac tamponade. It has been in routine use at Ulleval University Hospital since 1987. Our objective was to see the outcome of patients subjected to ET in recent times.
: One hundred and nine consecutive ET performed in our emergency department during a 6-year period were analyzed. Data were drawn from the hospital's trauma registry. Demographics, mechanism of injury, anatomic injuries, physiologic status, interventions, time lapse, and outcome 30 days after injury were registered prospectively.
: Ten of 27 patients with penetrating (37%) and 10 of 82 patients with blunt injuries (12%) survived, giving a total survival of 18%. Median (quartiles) for the following parameters were Injury Severity Score 38 (26-50), Revised Trauma Score 1.3 (0-3.9), Glasgow Coma Scale score 3 (3-6), and probability of survival 0.06 (0.001-0.22). Survivors from penetrating injuries had significantly lower Injury Severity Score (25 vs. 34, p = 0.003), higher Revised Trauma Score (3.92 vs. 0.00, p < 0.001), higher Glasgow Coma Scale score (8 vs. 3, p < 0.001), and higher probability of survival (0.74 vs. 0.01, p < 0.001) than nonsurvivors. Conversely, no such differences were found for patients with blunt injury. Multiple logistic regression analysis failed to reveal any predictors of survival.
: An overall survival of 18% suggests that ET is a life saving procedure. It is difficult to find good predictors of survival from logistic regression analysis. It should, for a trained trauma team, be a liberal attitude toward performing the procedure on the agonal patient.
急诊开胸手术（ET）是一种用于控制出血和缓解心脏压塞的挽救生命的手术。自1987年以来，它一直在乌勒瓦尔大学医院常规使用。我们的目的是观察近期接受急诊开胸手术患者的预后情况。
对6年间在我们急诊科连续进行的109例急诊开胸手术进行分析。数据来自医院的创伤登记处。前瞻性记录人口统计学资料、损伤机制、解剖学损伤、生理状态、干预措施、时间间隔以及伤后30天的预后情况。
27例穿透伤患者中有10例（37%）存活，82例钝性伤患者中有10例（12%）存活，总存活率为18%。以下参数的中位数（四分位数）分别为：损伤严重度评分38（26 - 50）、修正创伤评分1.3（0 - 3.9）、格拉斯哥昏迷量表评分3（3 - 6）以及存活概率0.06（0.001 - 0.22）。穿透伤幸存者的损伤严重度评分显著低于非幸存者（25对34，p = 0.003），修正创伤评分更高（3.92对0.00，p < 0.001），格拉斯哥昏迷量表评分更高（8对3，p < 0.001），存活概率也更高（0.74对0.01，p < 0.001）。相反，钝性伤患者未发现此类差异。多因素逻辑回归分析未能揭示任何存活的预测因素。
18%的总存活率表明急诊开胸手术是一种挽救生命的手术。通过逻辑回归分析很难找到良好的存活预测因素。对于训练有素的创伤团队而言，对濒死患者实施该手术应持较为宽松的态度。
