Hoffmann C, Goudard Y, Falzone E, Leclerc T, Planchet M, Cazes N, Pons F, Lenoir B, Debien B
Département d'anesthésie-réanimation, hôpital d'instruction des armées Percy, BP 406, 101, avenue Henri-Barbusse, 92141 Clamart cedex, France.
Ann Fr Anesth Reanim. 2013 Feb;32(2):104-11. doi: 10.1016/j.annfar.2012.12.006. Epub 2013 Feb 8.
Penetrating traumas are rare in France and mainly due to stabbing. Knives are less lethal than firearms. The initial clinical assessment is the cornerstone of hospital care. It remains a priority and can quickly lead to a surgical treatment first. Urgent surgical indications are hemorrhagic shock, evisceration and peritonitis. Dying patients should be immediately taken to the operating room for rescue laparotomy or thoracotomy. Ultrasonography and chest radiography are performed before damage control surgery for hemodynamic unstable critical patients. Stable patients are scanned by CT and in some cases may benefit from non-operative strategy. Mortality remains high, initially due to bleeding complications and secondarily to infectious complications. Early and appropriate surgery can reduce morbidity and mortality. Non-operative strategy is only possible in selected patients in trained trauma centers and with intensive supervision by experienced staff.
穿透性创伤在法国较为罕见,主要由刺伤所致。刀具的致死性低于枪支。初始临床评估是医院救治的基石。它仍是首要任务,且可能迅速首先导致手术治疗。紧急手术指征为失血性休克、脏器脱出和腹膜炎。濒死患者应立即送往手术室进行抢救性剖腹手术或开胸手术。对于血流动力学不稳定的重症患者,在进行损伤控制手术前需进行超声检查和胸部X线摄影。病情稳定的患者进行CT扫描,某些情况下可能受益于非手术策略。死亡率仍然很高,最初是由于出血并发症,其次是感染并发症。早期且恰当的手术可降低发病率和死亡率。非手术策略仅适用于经过培训的创伤中心中经过挑选的患者,并由经验丰富的工作人员进行密切监测。