Yoong Isabelle Rui Wen, Heng Gregory, Mathur Sachin, Lim Woan Wui, Goo Tiong Thye
1 Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
2 Department of Surgery, 371018 Khoo Teck Puat Hospital , 90 Yishun Central, Singapore 768828.
Asian Cardiovasc Thorac Ann. 2018 May;26(4):285-289. doi: 10.1177/0218492318772221. Epub 2018 Apr 18.
Background An emergency thoracotomy can be performed either immediately at the site of trauma or in the emergency department or operating room for resuscitation of patients in extremis or life-saving treatment for patients with thoracic injury. It remains a procedure associated with high mortality rates, and there is a paucity of data from Asia. This study analyzed our six-year experience of emergency trauma thoracotomy in an acute general hospital in Singapore. Methods This retrospective analysis was based on experience in a single institution with all emergency trauma thoracotomies performed by general surgeons. All patients who underwent an emergency trauma thoracotomy in Khoo Teck Puat Hospital between January 2011 and December 2016 were studied. Data collected included patient demographics, mechanism of injury, Injury Severity Scores, surgical approach, and postoperative outcomes. Results Twenty-three patients underwent an emergency thoracotomy, 8 in the emergency department and 15 in the operating room. The mechanism of injury was blunt in 20 (87%) patients and penetrating in 3 (13%), with road traffic accidents the most common cause (70%). Six (40%) patients who underwent an emergency thoracotomy in the operating room survived beyond 24 h, and 4 (27%) survivors were eventually discharged from the hospital with no neurological deficit. No patient who underwent a thoracotomy in the emergency department survived beyond 24 h. Conclusions Emergency thoracotomy is associated with high mortality rates, especially when required in the emergency department or for blunt trauma. Nevertheless, it is a potentially life-saving procedure that offers a chance of survival in selected patients.
背景 急诊开胸手术可在创伤现场即刻进行，也可在急诊科或手术室进行，用于抢救濒死患者或对胸部损伤患者进行挽救生命的治疗。该手术死亡率仍然较高，且亚洲地区的数据较少。本研究分析了我们在新加坡一家急性综合医院进行急诊创伤开胸手术的六年经验。方法 本回顾性分析基于单一机构普通外科医生进行的所有急诊创伤开胸手术经验。研究了2011年1月至2016年12月在 Khoo Teck Puat 医院接受急诊创伤开胸手术的所有患者。收集的数据包括患者人口统计学资料、损伤机制、损伤严重程度评分、手术方式和术后结果。结果 23例患者接受了急诊开胸手术，8例在急诊科进行，15例在手术室进行。损伤机制为钝性损伤的患者有20例（87%），穿透性损伤的患者有3例（13%），交通事故是最常见的原因（70%）。在手术室接受急诊开胸手术的6例（40%）患者存活超过24小时，4例（27%）幸存者最终出院，无神经功能缺损。在急诊科接受开胸手术的患者无一存活超过24小时。结论 急诊开胸手术死亡率较高，尤其是在急诊科进行或用于钝性创伤时。然而，这是一种潜在的挽救生命的手术，为部分患者提供了生存机会。
