Branco Bernardino C, Musonza Tashinga, Long Michael A, Chung Jayer, Todd Samual R, Wall Matthew J, Mills Joseph L, Gilani Ramyar
Division of Vascular Surgery & Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
J Vasc Surg. 2018 Dec;68(6):1880-1888. doi: 10.1016/j.jvs.2018.04.033. Epub 2018 Jun 28.
Recent studies have demonstrated an increase in trauma mortality relative to mortality from cancer and heart diseases in the United States. Major vascular injuries such as to the inferior vena cava (IVC) and aortic injuries remain responsible for a significant proportion of early trauma deaths in modern trauma care. The purpose of this study was to explore patterns in epidemiology and mortality after IVC and aortic injuries in the United States.
A 13-year analysis of the National Trauma Databank (2002-2014) was performed to extract all patients who sustained IVC, abdominal aortic, or thoracic aortic injuries. Demographics, clinical data, and outcomes were extracted. Patients were analyzed according to injury mechanism.
A total of 25,428 patients were included in this analysis. Overall, the mean age was 39.8 ± 19.1 years, 70.3% were male, and 14.1% sustained a penetrating trauma. Although the incidence of all three injuries remained constant throughout the study period, for blunt trauma, mortality decreased over the study period (from 48.8% in 2002 to 28.7% in 2014; P < .001), in particular for thoracic aortic injuries (from 46.1% in 2002 to 23.7% in 2014; P < .001) and abdominal aortic injuries (from 58.3% in 2002 to 26.2% in 2014; P < .001). This decrease in mortality after blunt trauma was accompanied by an increase in endovascular procedures over the study period (from 1.0% in 2002 to 30.4% in 2014; P < .001), in particular for blunt thoracic aortic injuries (from 0.7% in 2002 to 41.4% in 2014; P < .001). When penetrating trauma patients were analyzed, overall there was an increase in mortality (from 43.8% in 2002 to 50.6% in 2014; P < .001), in particular after abdominal aortic injury (from 30.4% in 2002 to 66.0% in 2014; P < .001). Similar trends were observed for IVC injuries. No increase in endovascular use in penetrating trauma was identified (from 0.1% in 2002 to 3.4% in 2014; P < .001).
The present study demonstrates an overall decrease in mortality after blunt aortic injuries in the United States. This decrease was accompanied by an increase in the use of endovascular procedures. After penetrating trauma, however, despite contemporary advances in trauma care, mortality has increased over the study period, in particular after abdominal aortic injury. No increase in endovascular use in penetrating trauma was demonstrated.
近期研究表明，在美国，创伤死亡率相对于癌症和心脏病死亡率有所上升。诸如下腔静脉（IVC）损伤和主动脉损伤等主要血管损伤在现代创伤护理中仍占早期创伤死亡的很大比例。本研究的目的是探讨美国IVC和主动脉损伤后的流行病学模式及死亡率。
对国家创伤数据库（2002 - 2014年）进行了为期13年的分析，以提取所有遭受IVC、腹主动脉或胸主动脉损伤的患者。提取了人口统计学、临床数据和结果。根据损伤机制对患者进行分析。
本分析共纳入25428例患者。总体而言，平均年龄为39.8±19.1岁，70.3%为男性，14.1%遭受穿透性创伤。尽管在整个研究期间，所有三种损伤的发生率保持不变，但对于钝性创伤，死亡率在研究期间有所下降（从2002年的48.8%降至2014年的28.7%；P <.001），特别是胸主动脉损伤（从2002年的46.1%降至2014年的23.7%；P <.001）和腹主动脉损伤（从2002年的58.3%降至2014年的26.2%；P <.001）。钝性创伤后死亡率的下降伴随着研究期间血管内手术的增加（从2002年的1.0%增至2014年的30.4%；P <.001），特别是钝性胸主动脉损伤（从2002年的0.7%增至2014年的41.4%；P <.001）。当分析穿透性创伤患者时，总体死亡率有所上升（从2002年的43.8%升至2014年的50.6%；P <.001），特别是腹主动脉损伤后（从2002年的30.4%升至2014年的66.0%；P <.001）。IVC损伤也观察到类似趋势。在穿透性创伤中未发现血管内手术使用的增加（从2002年的0.1%增至2014年的3.4%；P <.001）。
本研究表明美国钝性主动脉损伤后死亡率总体下降。这种下降伴随着血管内手术使用的增加。然而，在穿透性创伤后，尽管创伤护理有了当代进展，但在研究期间死亡率仍有所上升，特别是腹主动脉损伤后。在穿透性创伤中未证明血管内手术使用的增加。
