Howell Gina M, Peitzman Andrew B, Nirula Raminder, Rosengart Matthew R, Alarcon Louis H, Billiar Timothy R, Sperry Jason L
Division of General Surgery and Trauma, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
J Trauma. 2010 Jun;68(6):1296-300. doi: 10.1097/TA.0b013e3181d990b5.
Hemorrhage remains a leading cause of early death in injured patients, and definitive control of bleeding remains a fundamental principle of trauma management. Therapeutic interventional radiology (IR) procedures have increasingly become essential in the acute management of traumatic injury. The importance of time to control of hemorrhage for therapeutic IR procedures has not been adequately characterized.
A retrospective analysis was performed by using data derived from the National Trauma Data Bank, version 7.1. Inclusion criteria included the following: adult, hypotensive patients, scene admission, patients who underwent early therapeutic IR vascular occlusive procedures within in 3 hours of admission at a level I or II designated trauma center (n = 1,748). Exclusion criteria included intracranial or venous occlusion procedures, patients who underwent any abdominal, thoracic, vascular, or intracranial operative procedures throughout their entire hospital stay. Logistic regression analysis was used to analyze the independent mortality risk associated with DELAY to IR procedures after controlling for important confounders.
The majority of patients who died did so within the first 48 hours from injury (80%). Regression analysis revealed that DELAY to IR was independently associated with more than a twofold higher risk of mortality (odds ratio 2.7, 95% confidence interval 1.6-4.9, p < 0.001). For every hour delay, the risk of mortality increased by 47%. These findings were independent of injury mechanism and most pertinent to level I trauma centers.
In hemodynamically unstable trauma patients undergoing therapeutic catheter-based IR procedures, delay to IR was independently associated with more than a twofold higher risk of mortality. These results suggest that therapeutic IR procedures should be performed as expeditiously as possible and held to the same dogma as applied to definitive operative control of hemorrhage.
出血仍然是受伤患者早期死亡的主要原因，而有效控制出血仍然是创伤管理的基本原则。治疗性介入放射学（IR）程序在创伤急性管理中变得越来越重要。对于治疗性IR程序而言，控制出血的时间的重要性尚未得到充分描述。
使用来自国家创伤数据库7.1版的数据进行回顾性分析。纳入标准包括：成人、低血压患者、现场入院、在I级或II级指定创伤中心入院后3小时内接受早期治疗性IR血管闭塞程序的患者（n = 1748）。排除标准包括颅内或静脉闭塞程序、在整个住院期间接受任何腹部、胸部、血管或颅内手术程序的患者。在控制重要混杂因素后，使用逻辑回归分析来分析与IR程序延迟相关的独立死亡风险。
大多数死亡患者在受伤后的头48小时内死亡（80%）。回归分析显示，IR延迟与死亡风险高出两倍多独立相关（优势比2.7，95%置信区间1.6 - 4.9，p < 0.001）。每延迟一小时，死亡风险增加47%。这些发现与损伤机制无关，且与I级创伤中心最为相关。
在接受基于导管的治疗性IR程序的血流动力学不稳定的创伤患者中，IR延迟与死亡风险高出两倍多独立相关。这些结果表明，治疗性IR程序应尽快进行，并遵循与确定性手术控制出血相同的原则。
