Singh Amit, Prasad Ganpat, Mishra Prabhakar, Vishkarma Kuldeep, Shamim Rafat
Division of Trauma, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Division of Anaesthesia, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Turk J Surg. 2021 Sep 28;37(3):277-285. doi: 10.47717/turkjsurg.2021.4886. eCollection 2021 Sep.
The number of accident cases is increasing day by day, so as the challenges. With an emphasis on trauma care, the government started a 120 bedded level I trauma centre in northern India catering to a population of 2.8 million in June 2018. Through this article, we aimed to share our experience of blunt abdominal trauma management from a new level I trauma centre.
In this retrospective observational study, historical analysis of all available records from July 2018 to March 2020 was done. Inclusion criteria included blunt trauma abdomen with or without associated injuries. Data regarding age, sex, mechanism of injury, time taken to reach the hospital, the pattern of solid organs and hollow viscus injuries, associated extra abdominal injuries, mode of treatment, complications, length of ICU and hospital stay, and mortality were reviewed.
Overall, 154 cases sustained abdominal injuries during the study period. Seventy-five percent were male. The most common cause of blunt trauma abdomen was road traffic crashes. Operative management was required in 57 (37.01%) cases while 97(62.98%) were managed non-operatively (NOM). Mean ICU stay was 05.73 days, while the average hospital stay was 12 days (range 10-60 days). Procedures performed included splenectomy, liver repair, primary closure of bowel injury, and stoma formation. Complications occured in 16.88% cases and the overall mortality rate was 11.68%.
The study revealed that among 154 cases of fatal blunt abdominal trauma, road traffic crash was the most common cause of blunt abdominal trauma, predominantly affecting males. The visceral and peritoneal injury frequently perceived was liver in 40 cases (25.9%), spleen 66 (43%), intestine 21(13.6%) and kidney 13 cases (09%). Abdominal injury was associated with other injuries like head, chest and extremity injuries in 52.5% cases. Duration of injury, presence of associated injury and preoperative ventilation requirement were independent predictors of mortality apart from contributary factors such as clinical presentation, organ involved and presence of complications.
事故病例数量与日俱增，挑战也日益增大。在重视创伤护理的背景下，政府于2018年6月在印度北部设立了一家拥有120张床位的一级创伤中心，服务于280万人口。通过本文，我们旨在分享一家新建一级创伤中心在钝性腹部创伤管理方面的经验。
在这项回顾性观察研究中，对2018年7月至2020年3月期间所有可用记录进行了历史分析。纳入标准包括伴有或不伴有相关损伤的钝性腹部创伤。审查了有关年龄、性别、损伤机制、到达医院的时间、实体器官和中空脏器损伤的模式、相关的腹部外损伤、治疗方式、并发症、重症监护病房（ICU）住院时间和住院时间以及死亡率的数据。
总体而言，在研究期间有154例发生腹部损伤。其中75%为男性。钝性腹部创伤最常见的原因是道路交通事故。57例（37.01%）需要手术治疗，而97例（62.98%）接受非手术治疗（NOM）。ICU平均住院时间为5.73天，而平均住院时间为12天（范围为10 - 60天）。实施的手术包括脾切除术、肝脏修复、肠损伤一期缝合和造口术。16.88%的病例出现并发症，总体死亡率为11.68%。
该研究表明，在154例致命性钝性腹部创伤病例中，道路交通事故是钝性腹部创伤最常见的原因，主要影响男性。最常出现的内脏和腹膜损伤为肝脏40例（25.9%）、脾脏66例（43%）、肠道21例（13.6%）和肾脏13例（9%）。52.5%的病例腹部损伤与头部、胸部和四肢等其他损伤相关。除了临床表现、受累器官和并发症等促成因素外，受伤持续时间、相关损伤的存在以及术前通气需求是死亡率的独立预测因素。
