Zimmerman W Britt, Baylor Alfred E, Hall Zimmerman Lisa, Dolman Heather, Ciullo Jeremy R, Dornbush Jessica, Isaacson Andrew R, Mansour Roozbeh, Wilson Robert F, Tyburski James G
Urology, Michigan State University, East Lansing, USA.
The Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine, Detroit Receiving Hospital, Detroit, USA.
Cureus. 2020 Jan 31;12(1):e6826. doi: 10.7759/cureus.6826.
Introduction In patients having emergency abdominal surgery for trauma, the presence of urologic injury tends to increase mortality and morbidity. Methods This retrospective study evaluated patients requiring emergency surgery for abdominal trauma at a Level 1 Trauma Center over 30 years (1980-2010). Special attention was given to patients with concomitant genitourinary (GU) injuries. Results Of 1105 patients requiring an emergency laparotomy for trauma, 242 (22%) had urologic injuries including kidney 178 (16%), ureter 47 (4%), and bladder 46 (4%). Of the 242 patients, 50 (20%) died early (<48 hours) and 13 (5%) died later, primarily due to infection. A concept of "seven deadly signs" of hypoperfusion was developed. In patients with GU injuries, the presence of any deadly sign of hypoperfusion increased the mortality rate from 4% (6/152) to 63% (56/90), p<0.001. Of the 53 patients having a nephrectomy, 36 (68%) had one or more deadly signs and 27 (75%) died. Of 17 without deadly signs, only 2 (12%) died (p=0.001). Of 167 GU patients receiving blood, 59 (35%) developed infection vs 3/75(4%) in those receiving no blood (p<0.001). Conclusions The presence of deadly signs of severe injury and hypoperfusion on admission was the major factor determining mortality. With a severely injured kidney plus any deadly signs of hypoperfusion, special efforts should be made to avoid a nephrectomy.
引言 在因创伤接受急诊腹部手术的患者中，泌尿系统损伤的存在往往会增加死亡率和发病率。方法 这项回顾性研究评估了30年间（1980 - 2010年）在一级创伤中心因腹部创伤需要急诊手术的患者。特别关注伴有泌尿生殖系统（GU）损伤的患者。结果 在1105例因创伤需要急诊剖腹手术的患者中，242例（22%）有泌尿系统损伤，包括肾脏损伤178例（16%）、输尿管损伤47例（4%）和膀胱损伤46例（4%）。在这242例患者中，50例（20%）早期（<48小时）死亡，13例（5%）后期死亡，主要原因是感染。提出了低灌注“七个致命体征”的概念。在伴有GU损伤的患者中，任何低灌注致命体征的存在使死亡率从4%（6/152）增至63%（56/90），p<0.001。在53例行肾切除术的患者中，36例（68%）有一个或多个致命体征，27例（75%）死亡。在17例无致命体征的患者中，仅2例（12%）死亡（p = 0.001）。在167例接受输血的GU患者中，59例（35%）发生感染，而未输血的75例患者中3例（4%）发生感染（p<0.001）。结论 入院时严重损伤和低灌注的致命体征是决定死亡率的主要因素。对于严重损伤的肾脏加上任何低灌注致命体征的患者，应特别努力避免行肾切除术。
