Güsgen Christoph, Willms Arnulf, Richardsen Ines, Bieler Dan, Kollig Erwin, Schwab Robert
Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus, Koblenz, Deutschland.
Klinik für Unfallchirurgie und Orthopädie, Wiederherstellungs-, Hand- und plastische Chirurgie, Verbrennungsmedizin, Bundeswehrzentralkrankenhaus, Koblenz, Deutschland.
Zentralbl Chir. 2017 Aug;142(4):386-394. doi: 10.1055/s-0043-113821. Epub 2017 Aug 24.
Much like other countries, Germany has recently seen terrorist attacks being planned, executed or prevented at the last minute. This highlights the need for expertise in the treatment of penetrating torso traumas by bullets or explosions. Data on the treatment of firearm injuries and, even more so, blast injuries often stems from crises or war regions. However, it is difficult to compare injuries from such regions with injuries from civilian terrorist attacks due to the ballistic body protection (protective vests, body armour) worn by soldiers. An analysis was performed based on data from patients who were treated in the German Military Hospital Mazar-e Sharif for gunshots or injuries from explosions in the years 2009 to 2013. The data selection was based on patients with penetrating injuries to the thorax and/or abdomen. For better comparability with civilian attack scenarios, this study only included civilian patients without ballistic body protection (body armour, protective vests). Out of 117 analysed patients, 58 were affected by firearms and 59 by explosive injuries of the thorax or abdomen. 60% of patients had a thoracic injury, 69% had an abdominal injury, and 25.6% had combined thoracic-abdominal injuries. Blast injury patients were significantly more affected by thoracic trauma. As regards abdominal injuries, liver, intestinal, and colonic lesions were leading in number. Patients with blast injuries had significantly more injured organs and a significantly higher ISS averaging 29. 26% of the shot patients and 41% of the blast wounded patients received Damage Control Surgery (DCS). Despite a lower ISS, gunshot victims did not have a lower total number of operations per patient. Overall mortality was 13.7% (10.3% gunshot wounds, 16.7% blast injury). The highest mortality rate (25.7%) was recorded for patients with combined thoracoabdominal injuries (vs. 8.3% for thoracic and 8.7% for abdominal injuries). The ISS of deceased patients was significantly higher at 32.9%. Patients without ballistic protection of the torso have high mortality rates, especially when suffering thoracoabdominal blast injuries. Blast injuries frequently lead to the DCS indication. The care of firearm and blast injury patients requires knowledge and competence in the damage control procedures for thorax and abdomen.
与其他国家非常相似，德国最近也出现了恐怖袭击事件，这些袭击有的在策划阶段，有的已实施，还有的在最后一刻被阻止。这凸显了在治疗子弹或爆炸导致的穿透性躯干创伤方面专业知识的必要性。关于火器伤治疗的数据，甚至更多关于爆炸伤的数据，往往来自危机地区或战区。然而，由于士兵穿着防弹身体防护装备（防弹背心、防弹衣），很难将这些地区的损伤与平民恐怖袭击造成的损伤进行比较。基于2009年至2013年在德国马扎里沙里夫军事医院接受枪伤或爆炸伤治疗的患者数据进行了分析。数据选择基于胸部和/或腹部有穿透伤的患者。为了更好地与平民袭击场景进行比较，本研究仅纳入了没有防弹身体防护装备（防弹衣、防弹背心）的平民患者。在117名分析患者中，58人受火器伤，59人受胸部或腹部爆炸伤。60%的患者有胸部损伤，69%有腹部损伤，25.6%有胸部和腹部联合损伤。爆炸伤患者受胸部创伤的影响明显更大。在腹部损伤方面，肝脏、肠道和结肠损伤数量居多。爆炸伤患者受伤器官明显更多，损伤严重度评分（ISS）平均为29，显著更高。26%的枪伤患者和41%的爆炸伤患者接受了损伤控制手术（DCS）。尽管ISS较低，但枪伤受害者每位患者的总手术次数并不少。总体死亡率为13.7%（枪伤为10.3%，爆炸伤为16.7%）。胸腹联合伤患者的死亡率最高（25.7%）（相比之下，胸部损伤为8.3%，腹部损伤为8.7%）。死亡患者的ISS显著更高，为32.9%。没有躯干防弹保护的患者死亡率很高，尤其是遭受胸腹爆炸伤时。爆炸伤经常导致损伤控制手术指征。火器伤和爆炸伤患者的护理需要具备胸部和腹部损伤控制程序方面的知识和能力。
