Webb Leland H, Patel Mayur B, Dortch Marcus J, Miller Richard S, Gunter Oliver L, Collier Bryan R
Department of Surgery, Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA.
J Emerg Trauma Shock. 2012 Apr;5(2):126-30. doi: 10.4103/0974-2700.96480.
The furosemide drip (FD), in addition to improving volume overload respiratory failure, has been used to decrease fluid in attempts to decrease intra-abdominal and abdominal wall volumes to facilitate fascial closure. The purpose of this study is to evaluate the FD and the associated rate of primary fascial closure following trauma damage control laparotomy (DCL).
From January 2004 to September 2008, a retrospective review from a single institution Trauma Registry of the American College of Surgeons dataset was performed. All DCLs greater than 24 h who had a length of stay for 3 or more days were identified. The study group (FD+) and control group (FD-) were compared. Demographic data including age, sex, probability of survival, red blood cell transfusions, initial lactate, and mortality were collected. Primary outcomes included primary fascial closure and primary fascial closure within 7 days. Secondary outcomes included total ventilator days and LOS.
A total of 139 patients met inclusion criteria: 25 FD+ and 114 FD-. The 25 FD+ patients received the drug at a median 4 days post DCL. Demographic differences between the groups were not significantly different, except that initial lactate was higher for FD- (1.7 vs 4.0; P=0.03). No differences were noted between groups regarding successful primary fascial closure (FD+ 68.4% vs FD- 64.0%; P=0.669), or closure within 7 days (FD+13.2% vs FD- 28.0%; P=0.066) of original DCL. FD+ patients suffered more open abdomen days (4 [2-7] vs 2 [1-4]; P=0.001). FD+ did not demonstrate an association with primary fascial closure [Odds ratio (OR) 1.5, 95% confidence interval (CI) 0.260-8.307; P=0.663]. FD+ patients had more ventilator days and longer Intensive Care Unit (ICU)/hospital LOS (P<0.01).
FD use may remove excess volume; however, forced diuresis with an FD is not associated with an increased rate of primary closure after DCL. Further studies are warranted to identify ICU strategies to facilitate fascial closure in DCL.
速尿滴注（FD）除了可改善容量超负荷导致的呼吸衰竭外，还被用于减少液体量，试图减小腹腔内和腹壁容量以促进筋膜闭合。本研究的目的是评估FD以及创伤损害控制剖腹术（DCL）后一期筋膜闭合的相关发生率。
对2004年1月至2008年9月期间美国外科医师学会数据集单个机构创伤登记处的数据进行回顾性分析。确定所有持续时间超过24小时且住院时间为3天或更长时间的DCL患者。比较研究组（FD+）和对照组（FD-）。收集包括年龄、性别、生存概率、红细胞输注、初始乳酸水平和死亡率在内的人口统计学数据。主要结局包括一期筋膜闭合以及7天内的一期筋膜闭合。次要结局包括总机械通气天数和住院时间。
共有139例患者符合纳入标准：25例FD+和114例FD-。25例FD+患者在DCL后中位4天接受该药物治疗。除FD-组初始乳酸水平较高外（1.7对4.0；P = 0.03），两组间人口统计学差异无统计学意义。在一期筋膜闭合成功方面（FD+组68.4%对FD-组64.0%；P = 0.669），或在原DCL后7天内闭合方面（FD+组13.2%对FD-组28.0%；P = 0.066），两组间未观察到差异。FD+组患者开放性腹部天数更多（4[2 - 7]对2[1 - 4]；P = 0.001）。FD+与一期筋膜闭合无相关性[比值比（OR）1.5，95%置信区间（CI）0.260 - 8.307；P = 0.663]。FD+组患者机械通气天数更多，重症监护病房（ICU）/住院时间更长（P < 0.01）。
使用FD可能会消除过多的液体量；然而，FD强制利尿与DCL后一期闭合率增加无关。有必要进一步研究以确定促进DCL中筋膜闭合的ICU策略。
