Hoyt D B, Shackford S R, Davis J W, Mackersie R C, Hollingsworth-Fridlund P
Department of Surgery, University of California, San Diego.
J Trauma. 1989 Oct;29(10):1318-21. doi: 10.1097/00005373-198910000-00003.
As trauma systems have developed and board-certified in-house surgeons are now immediately available, enthusiasm has returned for thoracotomy as part of initial resuscitation. This study evaluated the impact of thoracotomy by board-certified surgeons during the resuscitative phase of treatment. Resuscitative thoracotomy, performed on patients in cardiac arrest within 20 minutes of arrival in the hospital, was undertaken in 113 of 4,752 patients over a 4 1/2-year period. Resuscitative thoracotomy added nothing to beneficial survival in patients with a blunt mechanism despite the addition of a board-certified surgeon. Survivors of penetrating injury had a probability of survival (Ps) of 0.48. Most patients suffering penetrating deaths had severe and advanced physiologic derangements at the time of admission despite similar anatomic injuries to survivors.
随着创伤系统的发展以及医院内部具备委员会认证资质的外科医生随时可供调用，人们对开胸手术作为初始复苏的一部分又重新燃起了热情。本研究评估了委员会认证的外科医生在治疗复苏阶段进行开胸手术的影响。在4年半的时间里，4752例患者中有113例在入院后20分钟内发生心脏骤停时接受了复苏性开胸手术。尽管增加了委员会认证的外科医生，但复苏性开胸手术对钝性机制损伤患者的有益生存没有任何帮助。穿透性损伤的幸存者生存概率（Ps）为0.48。尽管穿透性损伤死亡的大多数患者与幸存者的解剖损伤相似，但入院时存在严重且晚期的生理紊乱。
