2014-2017 年叙利亚大马士革武装冲突中的与战争相关的创伤性脑损伤：一项队列研究和文献综述。
War-related traumatic brain injuries during the Syrian armed conflict in Damascus 2014-2017: a cohort study and a literature review.
机构信息
Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Damascus University, Mazzah, Damascus, Syria.
Faculty of Medicine, Syrian Private University, Mazzah, Damascus, Syria.
出版信息
BMC Emerg Med. 2023 Mar 29;23(1):35. doi: 10.1186/s12873-023-00799-6.
BACKGROUND
The decade-long Syrian armed conflict killed or injured more than 11% of the Syrian population. Head and neck injuries are the most frequent cause of war-related trauma, about half of which are brain injuries. Reports about Syrian brain trauma victims were published from neighboring countries; However, none are available from Syrian hospitals. This study aims to report war-related traumatic brain injuries from the Syrian capital.
METHODS
We conducted a retrospective cohort study between 2014 and 2017 at Damascus Hospital, the largest public hospital in Damascus, Syria. Target patients were the victims of combat-related traumatic brain injuries who arrived alive and were admitted to the neurosurgery department or to another department but followed by the neurosurgery team. The collected data included the mechanism, type, and site of injury based on imaging findings; types of invasive interventions; intensive-care unit (ICU) admissions; as well as neurological status at admission and discharge including several severity scales.
RESULTS
Our sample consisted of 195 patients; Ninety-six of them were male young adults, in addition to 40 females and 61 children. Injuries were caused by shrapnel in 127 (65%) cases, and by gunshots in the rest, and most of them (91%) were penetrating. Sixty-eight patients (35%) were admitted to the ICU, and 56 (29%) underwent surgery. Neurological impairment was reported in 49 patients (25%) at discharge, and the mortality rate during hospitalization was 33%. Mortality and neurological impairment associated significantly with higher values on clinical and imaging severity scores.
CONCLUSIONS
This study captured the full spectrum of war-related brain injuries of civilians and armed personnel in Syria without the delay required to transport patients to neighboring countries. Although the clinical presentation of injuries at admission was not as severe as that in previous reports, the inadequate resources (i.e., ventilators and operation rooms) and the lack of previous experience with similar injuries might have resulted in the higher mortality rate. Clinical and imaging severity scales can provide a handy tool in identifying cases with low probability of survival especially with the shortage of personal and physical resources.
背景
长达十年的叙利亚武装冲突导致该国超过 11%的人口伤亡。头部和颈部受伤是战争相关创伤的最常见原因，其中约一半是脑损伤。有关叙利亚脑外伤患者的报告是从邻国发布的；然而，叙利亚医院没有相关报告。本研究旨在报告来自叙利亚首都的与战争有关的创伤性脑损伤。
方法
我们在叙利亚大马士革的最大公立医院大马士革医院进行了一项 2014 年至 2017 年的回顾性队列研究。目标患者是活着到达医院并被神经外科部门或其他部门收治但随后由神经外科团队跟进的与战斗有关的创伤性脑损伤受害者。收集的数据包括基于影像学发现的损伤机制、类型和部位；侵入性干预类型；重症监护病房（ICU）入院情况；以及入院和出院时的神经状态，包括几种严重程度量表。
结果
我们的样本包括 195 名患者；其中 96 名是年轻男性，40 名是女性，61 名是儿童。127 例（65%）损伤由弹片引起，其余由枪击引起，其中大多数（91%）是穿透性的。68 例（35%）患者被收入 ICU，56 例（29%）接受了手术。出院时报告 49 例（25%）存在神经功能障碍，住院期间死亡率为 33%。死亡率和神经功能障碍与临床和影像学严重程度评分较高显著相关。
结论
本研究在没有将患者转运到邻国所需的延迟的情况下，捕捉了叙利亚平民和武装人员与战争有关的脑损伤的全貌。尽管入院时的损伤临床表现不如以往报告的那么严重，但资源不足（即呼吸机和手术室）以及缺乏类似损伤的经验可能导致死亡率较高。临床和影像学严重程度量表可以提供一种方便的工具，特别是在个人和物力资源短缺的情况下，可以识别出存活可能性较低的病例。
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