Division of Trauma, Legacy Emanuel Medical Center, Portland, Oregon, USA.
J Trauma Acute Care Surg. 2012 Mar;72(3):601-6; discussion 606-8. doi: 10.1097/TA.0b013e31824483b7.
Temporary abdominal closure (TAC) has become a widely used technique in severely injured patients. However, there is growing concern that TAC is being overutilized. We sought to identify less severely injured patients who underwent TAC and to compare their outcomes with patients managed with a single-stage laparotomy (SSL).
This is a analysis of all trauma patients who underwent immediate laparotomy from 2005 to 2009. Risk modeling identified TAC patients who met all low-risk criteria: systolic blood pressure >90, no severe head injury, no combined solid + hollow viscus injury, or vascular injury. The low-risk cohort (LR-TAC) was compared with a matched similarly injured cohort managed with SSL using univariate and multivariate regression analysis.
Among the 282 patients undergoing TAC, 62 (22%) met low-risk criteria and were included in the LR-TAC group. There were 566 patients identified in the SSL group. There was no significant difference between groups for age, mechanism, Injury Severity Scores, associated injuries, base deficit, temperature, blood transfusion, solid organ injury, or bowel resection. The LR-TAC group had more hospital and ventilator days and increased complications rates (all p < 0.05). This included a higher rate of bowel ischemia/perforation with LR-TAC (7% vs. 0.7%). The use of TAC in the low-risk group was independently associated with increased complications (odds ratio 3.0, p = 0.01) and prolonged hospital stays (odds ratio 9.6, p < 0.01).
TAC was associated with increased morbidity and resource utilization when applied to less severely injured patients. Further study is indicated to clarify populations that may be harmed or benefitted by TAC.
: III, therapeutic study.
临时腹部闭合（TAC）已成为严重受伤患者广泛使用的技术。然而，人们越来越担心 TAC 被过度使用。我们试图确定接受 TAC 的受伤程度较轻的患者，并将其结果与接受单一阶段剖腹术（SSL）治疗的患者进行比较。
这是对 2005 年至 2009 年期间立即接受剖腹术的所有创伤患者的分析。风险模型确定了符合所有低危标准的 TAC 患者：收缩压>90mmHg，无严重头部损伤，无合并实性+中空内脏损伤，或血管损伤。使用单变量和多变量回归分析比较低危队列（LR-TAC）与接受 SSL 治疗的类似受伤队列。
在接受 TAC 的 282 例患者中，有 62 例（22%）符合低危标准，被纳入 LR-TAC 组。SSL 组有 566 例患者。两组之间在年龄、机制、损伤严重程度评分、合并损伤、基础缺陷、体温、输血、实质性器官损伤或肠切除术方面无显著差异。LR-TAC 组的住院和呼吸机天数以及并发症发生率均较高（均<0.05）。这包括 LR-TAC 组肠缺血/穿孔的发生率更高（7%比 0.7%）。低危组中 TAC 的使用与并发症增加独立相关（比值比 3.0，p=0.01）和住院时间延长（比值比 9.6，p<0.01）。
当应用于受伤程度较轻的患者时，TAC 与发病率增加和资源利用增加相关。需要进一步研究以阐明可能因 TAC 而受到伤害或受益的人群。
III 级，治疗性研究。
