Department of Surgery, Center for Translational Injury Research, University of Texas Medical Center, Houston, Tex., USA.
J Vasc Surg. 2013 Sep;58(3):695-700. doi: 10.1016/j.jvs.2013.02.034. Epub 2013 May 14.
The objective of this report is to describe our experience of pediatric vascular injuries in a U.S. military combat support hospital in Baghdad, Iraq. A retrospective study was designed using Joint Theater Trauma Registry (JTTR) records in order to evaluate the pediatric (age <18 years) population presenting with vascular trauma to a combat hospital in Baghdad, Iraq between April 2006 and August 2008. Demographic data comprised casualty, age, gender, and mechanism of injury. Physiologic data included presenting vital signs (rectal temperature, blood pressure, and heart rate), arterial pH, base deficit, hemoglobin (g/dL), and international normalized ratio.
Twenty-five children, median age 14 years (range, 5-17 years), median weight 48 kg (range, 15-80 kg) sustained 18 (72%) blast and 7 (28%) gunshot wounds. The mean Injury Severity Score was 25 ± 16.2. The median operative time for the vascular repairs was 189 minutes (range, 41-505 minutes). Patients were tachycardic (mean ± standard deviation, 136 ± 29 bpm), hypotensive (109/63 ± 29/19 mm Hg), and acidemic (pH 7.26 ± 0.07; BD -5.57 ± 5.1 mEq/L) on arrival to the emergency department and were physiologically improved upon admission to the intensive care unit 3 hours later. Repair techniques were ligation (14; 39%), saphenous graft (11; 31%), lateral suture (7; 19%), end anastomosis (2; 5%), patch (1; 3%), and thrombectomy (1; 3%). Twenty-four hour mean transfusion requirements included crystalloid 102 mL/kg (range, 19-253), transfused blood 47 mL/kg (range, 0-119), fresh frozen plasma 14 mL/kg (range, 0-68), and apheresis platelets (1.2 ± 3.68 units). Over a follow-up of 22 ± 5.5 days, the amputation-free survival was 80%.
This is the largest reported wartime series to demonstrate in children that damage control resuscitation despite high injury severity permits simultaneous limb salvage.
本报告旨在描述我们在美国巴格达的一家军事作战支援医院治疗小儿血管损伤的经验。采用联合战区创伤登记处（JTTR）记录进行回顾性研究，以评估 2006 年 4 月至 2008 年 8 月期间在巴格达一家作战医院就诊的小儿（年龄<18 岁）人群的血管损伤情况。人口统计学数据包括伤员、年龄、性别和损伤机制。生理数据包括就诊时的生命体征（直肠温度、血压和心率）、动脉 pH 值、碱缺失、血红蛋白（g/dL）和国际标准化比值。
25 名儿童，中位年龄 14 岁（范围 5-17 岁），中位体重 48kg（范围 15-80kg），18 例（72%）为爆炸伤，7 例（28%）为枪伤。损伤严重程度评分的平均值为 25 ± 16.2。血管修复的中位手术时间为 189 分钟（范围 41-505 分钟）。患者到达急诊室时心动过速（平均±标准差，136±29bpm）、低血压（109/63±29/19mmHg）和酸中毒（pH 7.26±0.07；BD-5.57±5.1mEq/L），3 小时后入住重症监护病房时生理状况改善。修复技术包括结扎（14 例；39%）、大隐静脉移植（11 例；31%）、外侧缝合（7 例；19%）、端端吻合（2 例；5%）、修补（1 例；3%）和血栓切除术（1 例；3%）。24 小时平均输血需求包括晶体液 102ml/kg（范围 19-253ml）、输血量 47ml/kg（范围 0-119ml）、新鲜冷冻血浆 14ml/kg（范围 0-68ml）和浓缩血小板（1.2±3.68 单位）。在 22±5.5 天的随访中，无截肢生存率为 80%。
这是迄今为止报告的最大规模的战争系列研究，表明在儿童中，尽管损伤严重程度高，但采用损伤控制性复苏可以同时实现肢体挽救。
