General Surgery and Department of Anesthesia, Division of Critical Care, University of Western Ontario, London Health Sciences Centre, 800 Commissioner’s Road East, London, Ontario.
Can J Surg. 2011 Dec;54(6):S130-4. doi: 10.1503/cjs.006611.
In the war against the Taliban, Canada was the lead North Atlantic Treaty Organization (NATO) nation to provide medical and surgical care to NATO soldiers, Afghanistan National Army soldiers, Afghanistan Nation Police, civilians working in and outside Kandahar Airfield and Afghanistan civilians at the Role 3 Multinational Medical Unit (R3MMU) from February 2006 to October 2009.
We obtained data from the Joint Theatre Trauma Registry between May 1 and Oct. 15, 2009; 188 patients were admitted to the R3MMU intensive care unit (ICU). We analyzed the ICU data according to types and causes of trauma, mechanical ventilation prevalence, ICU medical and surgical complications, blood products utilization, length of stay in the ICU and mortality.
The admitting services were general surgery (35%), neurosurgery (29%), orthopedic surgery (18%) and internal medicine (3%). Improvised explosive devices (46%) and gunshot wounds (26%) were the main causes of ICU admissions. The mean injury severity score for all patients admitted to the ICU was 37, and 81% of ICU patients required mechanical ventilation for a mean duration of 3 days. The main ICU complications were coagulopathy (6.4%), aspiration pneumonia (4.3%), pneumothorax (3.7%) and wound infection (2.7%). The following blood products were most used: packed red blood cells (55%), fresh frozen plasma (54%), platelets (29%) and cryoprecipitate (23%). The average length of stay in the ICU was 4.3 days, and the survival rate was 93%.
The high survival rate suggests that ICU care is a necessary and vital resource for a trauma hospital in a war zone.
在与塔利班的战争中，加拿大是北约（NATO）中第一个在坎大哈空军基地（Kandahar Airfield）内外为北约士兵、阿富汗国民军（Afghan National Army）士兵、阿富汗国家警察（Afghan National Police）、在阿富汗工作的平民以及在 3 级多国医疗单位（Role 3 Multinational Medical Unit，R3MMU）工作的平民提供医疗和手术服务的国家，从 2006 年 2 月至 2009 年 10 月。
我们于 2009 年 5 月 1 日至 10 月 15 日期间从联合战区创伤登记处获得数据；有 188 名患者入住 R3MMU 重症监护病房（intensive care unit，ICU）。我们根据创伤类型和原因、机械通气的流行率、ICU 内的医疗和手术并发症、血液制品的使用、在 ICU 中的住院时间和死亡率来分析 ICU 数据。
入住的科室包括普通外科（35%）、神经外科（29%）、骨科（18%）和内科（3%）。简易爆炸装置（improvised explosive devices，IED）（46%）和枪伤（26%）是导致 ICU 收治的主要原因。入住 ICU 的所有患者的平均损伤严重程度评分（injury severity score，ISS）为 37，81%的 ICU 患者需要机械通气，平均时间为 3 天。ICU 内的主要并发症包括凝血功能障碍（coagulopathy，6.4%）、吸入性肺炎（aspiration pneumonia，4.3%）、气胸（pneumothorax，3.7%）和伤口感染（wound infection，2.7%）。最常使用的血液制品包括：浓缩红细胞（packed red blood cells，PRBC）（55%）、新鲜冷冻血浆（fresh frozen plasma，FFP）（54%）、血小板（platelets，PLT）（29%）和冷沉淀（cryoprecipitate，CRYO）（23%）。患者在 ICU 中的平均住院时间为 4.3 天，生存率为 93%。
高生存率表明 ICU 护理是战区创伤医院的一项必要和重要资源。
