Dhar Sakshi Mathur, Breite Matthew D, Barnes Stephen L, Quick Jacob A
Division of Acute Care Surgery, Department of Surgery, University of Missouri, Columbia, Missouri.
Respir Care. 2018 Aug;63(8):950-954. doi: 10.4187/respcare.05952. Epub 2018 Mar 13.
Pulmonary contusions are thought to worsen outcomes. We aimed to evaluate the effects of pulmonary contusion on mechanically ventilated trauma subjects with severe thoracic injuries and hypothesized that contusion would not increase morbidity.
We conducted a single-center, retrospective review of 163 severely injured trauma subjects (injury severity score ≥ 15) with severe thoracic injury (chest abbreviated injury score ≥ 3), who required mechanical ventilation for >24 h at a verified Level 1 trauma center. Subject data were analyzed for those with radiographic documentation of pulmonary contusion and those without. Statistical analysis was performed to determine the effects of coexisting pulmonary contusion in severe thoracic trauma.
Pulmonary contusion was present in 91 subjects (55.8%), whereas 72 (44.2%) did not have pulmonary contusions. Mean chest abbreviated injury score (3.54 vs 3.47, = .53) and mean injury severity score (32.6 vs 30.2, = .12) were similar. There was no difference in mortality (11 [12.1%] vs 9 [12.5%], > .99) or length of stay (16.29 d vs 17.29 d, = .60). Frequency of ventilator-associated pneumonia was comparable (43 [47.3%] vs 32 [44.4%], = .75). Subjects with contusions were more likely to grow methicillin-sensitive in culture (33 vs 10, = .004) as opposed to in culture (6 vs 13, = .003).
Overall, no significant differences were noted in mortality, length of stay, or pneumonia rates between severely injured trauma subjects with and without pulmonary contusions.
肺挫伤被认为会使预后恶化。我们旨在评估肺挫伤对严重胸部损伤的机械通气创伤患者的影响，并假设挫伤不会增加发病率。
我们对一家经认证的一级创伤中心的163名严重受伤的创伤患者（损伤严重程度评分≥15）进行了单中心回顾性研究，这些患者有严重胸部损伤（胸部简明损伤评分≥3），需要机械通气超过24小时。分析了有肺挫伤影像学记录和无肺挫伤影像学记录的患者数据。进行统计分析以确定严重胸部创伤中并存肺挫伤的影响。
91名患者（55.8%）存在肺挫伤，而72名患者（44.2%）没有肺挫伤。平均胸部简明损伤评分（3.54对3.47，P = 0.53）和平均损伤严重程度评分（32.6对30.2，P = 0.12）相似。死亡率（11例[12.1%]对9例[12.5%]，P>0.99）或住院时间（16.29天对17.29天，P = 0.60）没有差异。呼吸机相关性肺炎的发生率相当（43例[47.3%]对32例[44.4%]，P = 0.75）。有挫伤的患者在培养中更有可能培养出对甲氧西林敏感的金黄色葡萄球菌（33例对10例，P = 0.004），而培养出耐甲氧西林金黄色葡萄球菌的情况则相反（6例对13例，P = 0.003）。
总体而言，有和没有肺挫伤的严重受伤创伤患者在死亡率、住院时间或肺炎发生率方面没有显著差异。
