- Hospital das Clínicas da Faculdade de Medicina da USP, Departamento de Cirurgia de Emergência, Divisão de Cirurgia Geral e Trauma - São Paulo - SP - Brasil.
Rev Col Bras Cir. 2022 Sep 30;49:e20223259. doi: 10.1590/0100-6991e-20223259-en. eCollection 2022.
in recent decades, the extraperitoneal pelvic packing technique has been disseminated, but there are still few studies. Thus, it was decided to analyze the results of extraperitoneal pelvic tamponade, in patients with pelvic fracture and shock, in order to identify predictive factors for mortality.
a retrospective review of medical records of patients submitted to extraperitoneal pelvic packing was conduced. We analyzed their characteristics, prehospital and emergency room data, pelvic fracture classification, associated and severity injuries, laboratory and imaging exams, data on packing, arteriography, and other procedures performed, complications, hemodynamic parameters, and amount of transfused blood products before and after packing.
data were analyzed from 51 patients, who showed signs of shock from prehospital care, presence of acidosis, with high base deficit and arterial lactate levels. Most patients underwent multiple surgical procedures due to severe associated injuries. The incidence of coagulopathy was 70.58%, and overall mortality was 56.86%. The group of non-surviving patients presented significantly higher age, prehospital endotracheal intubation, and lower Glasgow Coma Scale scores (p<0.05). The same group presented, before and after extraperitoneal pelvic packing, significantly worse hemodynamic parameters of mean arterial pressure, pH, base deficit, hemoglobin, and arterial lactate (p<0.05). The non-surviving group received significantly more units of packed red blood cells, fresh frozen plasma and platelets within 24 hours following extraperitoneal pelvic packing (p<0.05).
age and base deficit are independent predictors of mortality in patients submitted to extraperitoneal pelvic packing.
近几十年来，腹膜外盆腔填塞技术已经得到了传播，但相关研究仍然较少。因此，我们决定分析腹膜外盆腔填塞治疗骨盆骨折合并休克患者的结果，以确定死亡率的预测因素。
回顾性分析了接受腹膜外盆腔填塞的患者的病历。我们分析了他们的特征、院前和急诊室数据、骨盆骨折分类、合并伤和严重程度损伤、实验室和影像学检查、填塞、血管造影和其他手术操作的数据、并发症、血流动力学参数以及填塞前后输血量。
对 51 例患者的数据进行了分析，这些患者从院前急救开始就表现出休克迹象，存在酸中毒，伴有高碱缺失和动脉血乳酸水平升高。大多数患者因严重合并伤而接受了多次手术。凝血功能障碍的发生率为 70.58%，总死亡率为 56.86%。非存活组患者的年龄、院前气管插管和格拉斯哥昏迷评分明显较低（p<0.05）。该组患者在腹膜外盆腔填塞前后的平均动脉压、pH 值、碱缺失、血红蛋白和动脉血乳酸等血流动力学参数明显更差（p<0.05）。非存活组患者在接受腹膜外盆腔填塞后 24 小时内接受的单位红细胞、新鲜冷冻血浆和血小板明显更多（p<0.05）。
年龄和碱缺失是接受腹膜外盆腔填塞的患者死亡的独立预测因素。
