Gelbard Rondi B, Karamanos Efstathios, Farhoomand Amin, Keeling William B, McDaniel Michael C, Wyrzykowski Amy D, Shafii Susan M, Rajani Ravi R
Division of Trauma Surgery and Surgical Critical Care, Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Glenn Memorial Building, Rm. 310, Atlanta, GA, 30303, USA.
Division of Surgery, Henry Ford Hospital/Wayne State University, Detroit, MI, USA.
Am J Surg. 2016 Oct;212(4):769-774. doi: 10.1016/j.amjsurg.2015.08.027. Epub 2015 Oct 22.
Post-traumatic pulmonary embolic events are associated with significant morbidity. Computed tomographic (CT) measurements can be predictive of right ventricular (RV) dysfunction after pulmonary embolus. However, it remains unclear whether these physiologic effects or clinical outcomes differ between early (<48 hours) vs late (≥48 hours) post-traumatic pulmonary embolism (PE).
All patients with traumatic injury and CT evidence of PE between 2008 and 2013 were identified. The study population was divided into 2 groups based on the time of diagnosis of the PE. The primary outcome was PE-related mortality.
Fifty patients were identified (14 early PE and 36 late PE). Patients sustaining a late PE had a higher PE-related mortality rate (16.7% vs 0%), larger RV diameters, RV/left ventricular diameter ratios, RV volumes, and RV/left ventricular volume ratios (all P < .05).
Early post-traumatic PE appears to be associated with fewer RV physiologic changes than late post-traumatic PE and may be representative of primary pulmonary thrombosis. It remains to be seen whether early CT findings of PE should be managed according to previously established guidelines for embolic disease.
创伤后肺栓塞事件与显著的发病率相关。计算机断层扫描（CT）测量可预测肺栓塞后右心室（RV）功能障碍。然而，创伤后肺栓塞（PE）早期（<48小时）与晚期（≥48小时）之间这些生理效应或临床结局是否存在差异仍不清楚。
确定2008年至2013年间所有有创伤性损伤且有CT证据显示PE的患者。根据PE诊断时间将研究人群分为两组。主要结局是与PE相关的死亡率。
共确定50例患者（14例早期PE和36例晚期PE）。发生晚期PE的患者与PE相关的死亡率更高（16.7%对0%），RV直径、RV/左心室直径比值、RV容积以及RV/左心室容积比值更大（所有P<.05）。
创伤后早期PE似乎比创伤后晚期PE引起的RV生理变化更少，可能代表原发性肺血栓形成。PE的早期CT表现是否应根据先前确立的栓塞性疾病指南进行处理仍有待观察。
