Ball Chad G, Williams Brian H, Tallah Clarisse, Salomone Jeffrey P, Feliciano David V
Departments of Surgery, University of Calgary, Foothills Medical Center, Calgary, Alberta, Canada.
J Trauma Manag Outcomes. 2013 Dec 21;7(1):11. doi: 10.1186/1752-2897-7-11.
Most deaths in patients with abdominal vascular injuries (ABVI) are caused by exsanguination and irreversible shock. Therefore, time to definitive hemorrhage control is an important factor affecting survival. The study goals were: (1) document current outcomes in patients with ABVI, and (2) compare outcomes to those from the era preceding improvements in an urban prehospital system.
A retrospective review of all patients with ABVI at an urban level 1 trauma center was completed. Patients injured prior to prehospital transport improvements (1991-1994) were compared to those following a reduction in transport times (1995-2004).
Of 388 patients, 70 (18%) arrived prior to prehospital improvements (1991-1994). Patient/injury demographics were similar in both groups (age, sex, penetrating mechanism; p > 0.05). The number of patients presenting with ABVI increased (23 vs. 35 per year; p < 0.05) concurrent to a reduction in transport times (27 vs. 20 minutes; p < 0.05). Patients were more frequently unstable (63% vs. 91%; p < 0.05). Regardless of the specific vessel, mortality increased (37% vs. 67%; p < 0.05) following prehospital improvements.
A reduction in urban transport times resulted in an increase in (1) the number of patients arriving with abdominal vascular injuries, (2) the proportion presenting in physiologic extremis, and (3) overall mortality.
腹部血管损伤（ABVI）患者的大多数死亡是由失血和不可逆休克引起的。因此，实现确定性出血控制的时间是影响生存的重要因素。本研究的目标是：（1）记录ABVI患者目前的治疗结果，（2）将结果与城市院前系统改善之前的时代进行比较。
对一家城市一级创伤中心的所有ABVI患者进行了回顾性研究。将院前转运改善之前（1991 - 1994年）受伤的患者与转运时间缩短之后（1995 - 2004年）的患者进行比较。
在388例患者中，70例（18%）在院前改善之前（1991 - 1994年）到达。两组患者/损伤的人口统计学特征相似（年龄、性别、穿透机制；p > 0.05）。ABVI患者的数量增加（每年23例对35例；p < 0.05），同时转运时间缩短（27分钟对20分钟；p < 0.05）。患者更频繁地处于不稳定状态（63%对91%；p < 0.05）。无论具体血管如何，院前改善后死亡率增加（37%对67%；p < 0.05）。
城市转运时间的缩短导致（1）腹部血管损伤患者到达数量增加，（2）生理极度不稳定患者的比例增加，以及（3）总体死亡率增加。
