Kocamer Şimşek Betül, Dokur Mehmet, Uysal Erdal, Çalıker Necdet, Gökçe Oruç Numan, Deniz İbrahim Kürşat, Uğur Murat, Geyik Murat, Kaya Mehmet, Dağlı Güner
Department of Anesthesiology and Reanimation, Sanko University Faculty of Medicine, Gaziantep-Turkey.
Ulus Travma Acil Cerrahi Derg. 2017 May;23(3):199-206. doi: 10.5505/tjtes.2016.95525.
During a war, many civilians are severely injured by firearms, bombs, and shrapnel. The triage of war injuries involves difficult and complicated processes requiring surgical procedures and patient monitoring in the Intensive Care Unit (ICU) of hospitals. In this study, we examine the demographic, traumatic, and critical care characteristics of cases injured during the civil war in Syria and requiring emergency surgery.
Electronic data of the traumatic, surgical, and ICU monitoring features of 707 patients admitted to Kilis Public Hospital between March 2012 and January 2013 were analyzed retrospectively RESULTS: Most of the patients reported having been injured due to firearms (83.75%). Of the 707 cases studied in this work, 93.2% was male. Male patients reported a mean age of 26.1±12.1 years, while pediatric cases reported a mean age of 11.7±3.41 years. The most frequently injured region of the body was the head-neck region (52.7%). The New Injury Severity Score (NISS) of the cases was 42.5±11.2 and their American Society of Anesthesiologists (ASA) score was 3.2±0.7. The number of cases with intraoperative exitus was 7, while the number of cases who had undergone damage control surgery was 204. The number of cases hospitalized in the ICU during the postoperative period was 233, and the average hospitalization duration in the ICU was 4.67±1.32 days. Among survivor patients, the first 24-hour invasive measurements (i.e., pH, hemoglobin, body temperature, and mean arterial blood pressure) and international normalized ratio were found to be high. The number of blood products used for surviving patients was fewer relative to that used for non-surviving patients, and these NISS of these patients was 29.7±10.1. The mortality rate of all patients followed up in the ICU after emergency surgery was 45%, and neurosurgical cases showed the lowest level of survival (24.1%).
The results of this study indicated that head-neck, chest-abdomen, and multiple body injuries are the most widely seen among civilians brought to Turkey because of gunshot injuries sustained during the Civil War in Syria. The number of emergency operations performed in the study sample was high, and critical care follow-up durations were long. In addition, the NISS and ASA scores of mortal cases were fairly high.
在战争期间，许多平民因枪支、炸弹和弹片而受重伤。战争伤员的分诊涉及复杂艰难的过程，需要在医院重症监护病房（ICU）进行外科手术及患者监测。在本研究中，我们调查了叙利亚内战期间受伤并需要急诊手术的病例的人口统计学、创伤及重症监护特征。
回顾性分析了2012年3月至2013年1月间入住基利斯公立医院的707例患者的创伤、手术及ICU监测特征的电子数据。结果：大多数患者报告因枪支受伤（83.75%）。在本研究的707例病例中，93.2%为男性。男性患者的平均年龄为26.1±12.1岁，儿科病例的平均年龄为11.7±3.41岁。身体最常受伤的部位是头颈部（52.7%）。病例的新损伤严重程度评分（NISS）为42.5±11.2，美国麻醉医师协会（ASA）评分为3.2±0.7。术中死亡病例数为7例，接受损伤控制手术的病例数为204例。术后入住ICU的病例数为233例，在ICU的平均住院时间为4.67±1.32天。在存活患者中，发现最初24小时的侵入性测量值（即pH值、血红蛋白、体温和平均动脉血压）及国际标准化比值较高。存活患者使用的血液制品数量相对于非存活患者较少，这些患者的NISS为29.7±10.1。急诊手术后在ICU接受随访的所有患者的死亡率为45%，神经外科病例的存活率最低（24.1%）。
本研究结果表明，因叙利亚内战期间遭受枪伤而被送往土耳其的平民中，头颈部、胸腹及多处身体损伤最为常见。研究样本中进行的急诊手术数量较多，重症监护随访时间较长。此外，死亡病例的NISS和ASA评分相当高。
