全国范围内心胸创伤中体外循环的应用：国家创伤数据库的回顾性分析。
Nationwide utilization of cardiopulmonary bypass in cardiothoracic trauma: A retrospective analysis of the National Trauma Data Bank.
机构信息
From the Division of Trauma and Acute Care Surgery (B.P.J., H.M.H., E.J.M., N.B.), and Department of Surgery (D.D., M.K., C.R.), Tufts Medical Center; Tufts Clinical and Translational Science Institute (J.L.B.), Tufts University; and Institute for Clinical Research and Health Policy Studies (J.L.B.), Tufts Medical Center, Boston, Massachusetts.
出版信息
J Trauma Acute Care Surg. 2021 Sep 1;91(3):501-506. doi: 10.1097/TA.0000000000003315.
BACKGROUND
The American College of Surgeons Committee on Trauma requires that all level I trauma centers have cardiopulmonary bypass (CPB) capabilities immediately available. Despite this mandate, there are limited data on the utilization and clinical outcomes among trauma patients requiring CPB in the management of injuries. The aim of this study was to evaluate the current use of CPB in the care of trauma patients.
METHODS
This is a retrospective analysis of the National Trauma Data Bank from 2010 to 2015. Adult patients sustaining cardiothoracic injuries who underwent surgical repair within the first 24 hours of admission were included. Propensity score matching was used to compare outcomes (in-hospital mortality, hospital length of stay (LOS), intensive care unit LOS, and complications) between patients who underwent CPB within the first 24 hours of admission and those with similar injuries who did not receive CPB.
RESULTS
A total of 28,481 patients who met the inclusion criteria were identified, of whom 319 underwent CPB. Three-hundred three CPB patients were matched to 895 comparison patients who did not undergo CPB. Overall in-hospital mortality was 35%. Patients who were not treated with CPB had a significantly higher in-hospital mortality compared with those treated with CBP (odds ratio, 1.57; 95% confidence interval, 1.16-2.12; p = 0.003); however, complications were significantly lower in those who did not receive CPB (odds ratio, 0.63; 95% confidence interval, 0.47-0.86; p = 0.003). Hospital LOS (non-CPB: mean, 13.4 ± 16.3 days; CPB: mean, 14.7 ± 15.1 days; p = 0.23) and intensive care unit LOS (non-CPB: mean, 9.9 ± 10.7 days; CPB: mean, 10.1 ± 9.7 days; p = 0.08) did not differ significantly between groups.
CONCLUSION
The use of CPB in the initial management of select cardiothoracic injuries is associated with a survival benefit. Further investigation is required to delineate which specific injuries would benefit the most from the use of CPB.
LEVEL OF EVIDENCE
Therapeutic, level IV.
背景
美国外科医师学会创伤委员会要求所有一级创伤中心都能立即获得心肺旁路（CPB）的支持。尽管有这样的规定，但关于创伤患者在管理损伤时需要 CPB 的使用情况和临床结果的数据有限。本研究的目的是评估 CPB 在创伤患者治疗中的当前应用。
方法
这是对 2010 年至 2015 年国家创伤数据库的回顾性分析。纳入在入院后 24 小时内接受心胸损伤手术修复的成年患者。采用倾向评分匹配比较在入院后 24 小时内接受 CPB 和未接受 CPB 治疗但具有相似损伤的患者的结局（院内死亡率、住院时间（LOS）、重症监护病房 LOS 和并发症）。
结果
共确定了 28481 名符合纳入标准的患者，其中 319 名接受了 CPB。303 名 CPB 患者与 895 名未接受 CPB 的对照患者匹配。总体院内死亡率为 35%。未接受 CPB 治疗的患者院内死亡率明显高于接受 CPB 治疗的患者（比值比，1.57；95%置信区间，1.16-2.12；p=0.003）；然而，未接受 CPB 治疗的患者并发症发生率明显较低（比值比，0.63；95%置信区间，0.47-0.86；p=0.003）。住院时间（非 CPB：平均 13.4±16.3 天；CPB：平均 14.7±15.1 天；p=0.23）和重症监护病房 LOS（非 CPB：平均 9.9±10.7 天；CPB：平均 10.1±9.7 天；p=0.08）在两组之间无显著差异。
结论
在选择的心胸损伤的初始治疗中使用 CPB 与生存获益相关。需要进一步研究以确定哪些特定的损伤最受益于 CPB 的使用。
证据水平
治疗性，IV 级。
Zotero 插件