Salamon Tal, Lerner Alexander, Rothem David, Altshuler Alexander, Karmeli Ron, Solomonov Evgeny, Biswas Seema
Vascular Surgery Unit, Ziv Medical Centre, Safed, Israel(1); Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.
Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel; Department of Orthopedic Surgery, Ziv Medical Center, Safed, Israel.
Injury. 2016 Apr;47(4):811-7. doi: 10.1016/j.injury.2016.02.008. Epub 2016 Feb 23.
As the Syrian civil war continues, medical care of the injured remains a priority for health facilities receiving casualties. Ziv Medical Centre, the closest hospital in Israel to the Syrian border, has received 500 casualties since February 2013. Seventeen of these patients had vascular injuries. This research reports the care of these seventeen patients and explores the challenges of treatment in patients with little antecedent clinical history and improvised initial care that may be complicated by delay to definitive care, sepsis and limb ischaemia.
Electronic and paper patient records were examined. Descriptive case series data are presented.
Fifteen of the 17 patients were male. The mean age was 20 years (range 8-30 years). Causes of injury included gunshot wounds (4 patients), shrapnel (multi-fragment) injury (12 patients), and 1 patient was run over and dragged behind a car. The time from injury to transfer to definitive care ranged from 5h to 7 days (mean 43 h). All but one patient had associated non-vascular multiple-trauma. Thirteen patients presented with limb ischaemia. Four patients had arterio-venous fistula (AVF) or pseudoaneurysm. There were 5 upper and 10 lower limb major vascular injuries. Three patients had neck vessel injuries. All patients were investigated with CT angiography and underwent surgical or endovascular intervention. In 12 patients, 4 vessels were debrided and re-anastomosed and 13 vessels bypassed. Endovascular repair was performed in 4 patients. After initial revascularisation, 4 patients went on to amputation. There were no deaths.
The injuries treated are heterogeneous, and reflect the range of high energy vascular trauma expected in conflict. The broad range of vascular solutions required to optimise outcomes, in particular, limb salvage, in turn, reflect the challenges of dealing with such injuries, especially within the context of sepsis, ischaemia and delay. As war continues, there is a pressing need to address the needs of patients with high energy injuries in austere environments where there is a dearth of health resources and where definitive care may be days away.
随着叙利亚内战的持续，对于接收伤员的医疗机构而言，救治伤者依然是首要任务。位于以色列境内距叙利亚边境最近的齐夫医疗中心自2013年2月以来已接收了500名伤员。其中17名患者存在血管损伤。本研究报告了对这17名患者的救治情况，并探讨了在几乎没有既往临床病史且初始救治措施简陋的患者中进行治疗所面临的挑战，这些挑战可能因确定性治疗延迟、脓毒症和肢体缺血而变得更加复杂。
检查了电子和纸质患者记录。呈现了描述性病例系列数据。
17名患者中有15名男性。平均年龄为20岁（范围8 - 30岁）。受伤原因包括枪伤（4例）、弹片（多碎片）伤（12例），还有1例患者被汽车碾压并拖行。从受伤到转至确定性治疗的时间为5小时至7天（平均43小时）。除1例患者外，所有患者均伴有非血管性多发伤。13例患者出现肢体缺血。4例患者有动静脉瘘（AVF）或假性动脉瘤。有5例上肢和10例下肢主要血管损伤。3例患者有颈部血管损伤。所有患者均接受了CT血管造影检查，并接受了手术或血管腔内干预。12例患者中，4条血管进行了清创和重新吻合，13条血管进行了旁路移植。4例患者进行了血管腔内修复。在初始血管再通后，4例患者最终接受了截肢手术。无死亡病例。
所治疗的损伤情况各异，反映了冲突中预期出现的高能血管创伤范围。为优化治疗效果，尤其是保肢，所需的广泛血管治疗方案反过来也反映了处理此类损伤的挑战，特别是在脓毒症、缺血和治疗延迟的背景下。随着战争的持续，迫切需要满足在医疗资源匮乏且确定性治疗可能延迟数天的严峻环境中高能损伤患者的需求。
