Halonen-Watras Jill, O'Connor James, Scalea Thomas
R Adams Cowley Shock Trauma Center, University of Maryland Medical System, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
Am Surg. 2011 Apr;77(4):493-7.
The combination of respiratory insufficiency, right heart failure, and depth of shock is thought to result in mortality approaching 100 per cent after pneumonectomy. We did a retrospective review of patients requiring pneumonectomy over 6 years. Data collected included demographics, emergency department and operating room course, critical care management, complications, and mortality. Seven patients were identified. Mean age was 26.5 years. Five sustained penetrating and two sustained blunt trauma. Mean Injury Severity Score was 26 and Revised Trauma Score was 4.4. Mean admission systolic blood pressure, lactate, and pH were 98 mm Hg, 10.1 mmol/L, and 6.98, respectively. Mean time to operation was 49 minutes. Mean estimated blood loss was 5.4 liters and mean intraoperative transfusion was 13.1 units of packed red blood cells. All seven developed right heart failure. Four required prone ventilation, one oscillating ventilation, four continuous renal replacement, and three extracorporeal membrane oxygenation. Four patients died (57%); two of refractory right heart failure within the first 24 hours and two of multiple organ failure on postoperative days 9 and 138. Mean length of stay in survivors was 71 days. All survivors were neurologically intact and none required mechanical ventilation at discharge. The need for pneumonectomy after trauma is rare. Patients undergoing pneumonectomy who present in extremis require significant intra and postoperative support, with a survival of 42 per cent.
呼吸功能不全、右心衰竭和休克深度相结合被认为会导致肺切除术后死亡率接近100%。我们对6年期间需要进行肺切除术的患者进行了回顾性研究。收集的数据包括人口统计学资料、急诊科和手术室病程、重症监护管理、并发症及死亡率。共确定了7例患者。平均年龄为26.5岁。其中5例为穿透伤，2例为钝性伤。平均损伤严重度评分26分，改良创伤评分4.4分。入院时平均收缩压、乳酸水平和pH值分别为98 mmHg、10.1 mmol/L和6.98。平均手术时间为49分钟。平均估计失血量为5.4升，术中平均输注浓缩红细胞13.1单位。所有7例患者均出现右心衰竭。4例需要俯卧位通气，1例需要振荡通气，4例需要持续肾脏替代治疗，3例需要体外膜肺氧合。4例患者死亡（57%）；2例在最初24小时内因难治性右心衰竭死亡，2例在术后第9天和138天因多器官功能衰竭死亡。幸存者的平均住院时间为71天。所有幸存者神经功能均完好，出院时均无需机械通气。创伤后需要进行肺切除术的情况很少见。处于危急状态下接受肺切除术的患者需要大量的术中及术后支持，生存率为42%。
