Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ.
Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, AZ.
J Am Coll Surg. 2014 Jan;218(1):58-65. doi: 10.1016/j.jamcollsurg.2013.08.018. Epub 2013 Sep 18.
Gunshot wounds to the brain are the most lethal of all firearm injuries, with reported survival rates of 10% to 15%. The aim of this study was to determine outcomes in patients with gunshot wounds to the brain, presenting to our institution over time. We hypothesized that aggressive management can increase survival and the rate of organ donation in patients with gunshot wounds to the brain.
We analyzed all patients with gunshot wounds to the brain presenting to our level 1 trauma center over a 5-year period. Aggressive management was defined as resuscitation with blood products, hyperosmolar therapy, and/or prothrombin complex concentrate (PCC). The primary outcome was survival and the secondary outcome was organ donation.
There were 132 patients with gunshot wounds to the brain, and the survival rates increased incrementally every year, from 10% in 2008 to 46% in 2011, with the adoption of aggressive management. Among survivors, 40% (16 of 40) of the patients had bi-hemispheric injuries. Aggressive management with blood products (p = 0.02) and hyperosmolar therapy (p = 0.01) was independently associated with survival. Of the survivors, 20% had a Glasgow Coma Scale score ≥ 13 at hospital discharge. In patients who died (n = 92), 56% patients were eligible for organ donation, and they donated 60 organs.
Aggressive management is associated with significant improvement in survival and organ procurement in patients with gunshot wounds to the brain. The bias of resource use can no longer be used to preclude trauma surgeons from abandoning aggressive attempts to save patients with gunshot wound to the brain.
颅脑枪伤是所有火器伤中最致命的，报道的存活率为 10%至 15%。本研究旨在确定随着时间的推移，我院收治的颅脑枪伤患者的结局。我们假设积极的治疗可以提高颅脑枪伤患者的存活率和器官捐献率。
我们分析了 5 年来我院收治的所有颅脑枪伤患者。积极治疗定义为使用血液制品、高渗治疗和/或凝血酶原复合物浓缩物（PCC）复苏。主要结局是存活率，次要结局是器官捐献。
共有 132 例颅脑枪伤患者，随着积极治疗的采用，存活率逐年递增，从 2008 年的 10%增加到 2011 年的 46%。在幸存者中，40%（40 例中的 16 例）有双侧半球损伤。积极使用血液制品（p = 0.02）和高渗治疗（p = 0.01）与存活率独立相关。在幸存者中，20%的患者在出院时格拉斯哥昏迷评分≥13。在死亡患者（n = 92）中，56%的患者符合器官捐献条件，共捐献了 60 个器官。
积极治疗与颅脑枪伤患者的生存率和器官获取显著改善相关。资源利用的偏见不能再用来阻止创伤外科医生放弃对颅脑枪伤患者积极抢救的尝试。
