From the Department of Surgery (A.A.S., J.E.O., S.W., S.B., C.G., P.M., C.M., J.D., R.S.), Tulane University School of Medicine; and Section of Emergency Medicine (J.E.), Louisiana State University School of Medicine, New Orleans, Louisiana.
J Trauma Acute Care Surg. 2019 Jan;86(1):43-51. doi: 10.1097/TA.0000000000002095.
Despite increasing popularity of prehospital tourniquet use in civilians, few studies have evaluated the efficacy and safety of tourniquet use. Furthermore, previous studies in civilian populations have focused on blunt trauma patients. The objective of this study was to determine if prehospital tourniquet use in patients with major penetrating trauma is associated with differences in outcomes compared to a matched control group.
An 8-year retrospective analysis of adult patients with penetrating major extremity trauma amenable to tourniquet use (major vascular trauma, traumatic amputation and near-amputation) was performed at a Level I trauma center. Patients with prehospital tourniquet placement (TQ) were identified and compared to a matched group of patients without tourniquets (N-TQ). Univariate analysis was used to compare outcomes in the groups.
A total of 204 patients were matched with 127 (62.3%) in the prehospital TQ group. No differences in patient demographics or injury severity existed between the two groups. Average time from tourniquet application to arrival in the emergency department (ED) was 22.5 ± 1.3 minutes. Patients in the TQ group had higher average systolic blood pressure on arrival in the ED (120 ± 2 vs. 112 ± 2, p = 0.003). The TQ group required less total PRBCs (2.0 ± 0.1 vs. 9.3 ± 0.6, p < 0.001) and FFP (1.4 ± 0.08 vs. 6.2 ± 0.4, p < 0.001). Tourniquets were not associated with nerve palsy (p = 0.330) or secondary infection (p = 0.43). Fasciotomy was significantly higher in the N-TQ group (12.6% vs. 31.4%, p < 0.0001) as was limb amputation (0.8% vs. 9.1%, p = 0.005).
This study demonstrated that prehospital tourniquets could be safely used to control bleeding in major extremity penetrating trauma with no increased risk of major complications. Prehospital tourniquet use was also associated with increased systolic blood pressure on arrival to the ED, decreased blood product utilization and decreased incidence of limb related complications, which may lead to improved long-term outcomes and increased survival in trauma patients.
Therapeutic, level IV.
尽管在平民中使用院前止血带的普及度越来越高，但很少有研究评估止血带的疗效和安全性。此外，以前在平民人群中的研究主要集中在钝性创伤患者上。本研究的目的是确定在主要穿透性创伤患者中使用院前止血带是否与与对照组相比存在差异。
对一级创伤中心进行了一项 8 年回顾性分析，研究对象为适合使用止血带的成人穿透性主要肢体创伤患者（主要血管创伤、创伤性截肢和近截肢）。确定并比较了院前使用止血带（TQ）的患者与未使用止血带（N-TQ）的患者。采用单因素分析比较两组患者的结果。
共匹配了 204 名患者，其中 127 名（62.3%）患者在院前 TQ 组。两组患者的人口统计学和损伤严重程度无差异。从止血带应用到到达急诊部（ED）的平均时间为 22.5 ± 1.3 分钟。TQ 组患者到达 ED 时的平均收缩压更高（120 ± 2 对 112 ± 2，p = 0.003）。TQ 组患者需要的总 PRBC 更少（2.0 ± 0.1 对 9.3 ± 0.6，p < 0.001）和 FFP（1.4 ± 0.08 对 6.2 ± 0.4，p < 0.001）。止血带并不增加神经麻痹（p = 0.330）或继发感染（p = 0.43）的风险。筋膜切开术在 N-TQ 组中明显更高（12.6%对 31.4%，p < 0.0001），肢体截肢率也更高（0.8%对 9.1%，p = 0.005）。
本研究表明，院前止血带可安全用于控制主要肢体穿透性创伤的出血，且不会增加主要并发症的风险。院前止血带的使用还与 ED 到达时的收缩压升高、血液制品使用减少和肢体相关并发症发生率降低有关，这可能导致创伤患者的长期预后改善和生存率提高。
治疗，IV 级。
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