Read David J, Wong Jessica, Liu Raine, Gumm Kellie, Anderson David
The Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.
ANZ J Surg. 2023 Jul-Aug;93(7-8):1896-1900. doi: 10.1111/ans.18492. Epub 2023 May 7.
Prehospital tourniquets (PHTQ) for trauma have been shown to be safe and effective in the military environment and in some civilian settings. However, the supporting civilian data are mostly from North America with a differing case mix and trauma system and may not be applicable to the Australian environment. The aim of this study is to describe our initial experience with PHTQ from safety and efficacy viewpoints.
Retrospective review of all patients with PHTQ from 1 August 2016 to 31 December 2019 was conducted. Data were matched from the RMH Trauma Registry and Ambulance Victoria Registry. Clinical presentation including prehospital observations, PHTQ times, limb outcomes and complications are described.
Thirty-one cases met inclusion criteria, for whom median age was 37 (IQR: 23.9-66.3), median ISS 17 (13-34) and 80.6% were male. The majority (n = 19, 61.3%) were as a result of road traffic crash, and six (19.4%) from penetrating mechanisms, usually glass. Over a quarter (29.0%) suffered a traumatic amputation. The median prehospital SBP was 100 (IQR: 80-110), the median prehospital HR was 101 (IQR: 77.0-122.3) and was the median PHTQ time was 124 min (IQR: 47-243). Complications attributable to the tourniquet were seen in 4/30 cases (13.3%).
This Australian series differs from North American civilian PHTQ series with a lower penetrating trauma rate and longer PHTQ times. Despite this, complication rates are within the published literature's range. Concerns regarding limited transferability of overseas studies to the Australian context suggests that ongoing audit is required.
创伤院前止血带（PHTQ）在军事环境和一些民用环境中已被证明是安全有效的。然而，支持民用的相关数据大多来自北美，其病例组合和创伤系统不同，可能不适用于澳大利亚的环境。本研究的目的是从安全性和有效性的角度描述我们使用PHTQ的初步经验。
对2016年8月1日至2019年12月31日期间所有使用PHTQ的患者进行回顾性研究。数据来自皇家墨尔本医院创伤登记处和维多利亚救护车登记处。描述了临床表现，包括院前观察、PHTQ使用时间、肢体结局和并发症。
31例符合纳入标准，其中位年龄为37岁（四分位间距：23.9 - 66.3），中位损伤严重度评分（ISS）为17分（13 - 34），80.6%为男性。大多数（n = 19，61.3%）是道路交通事故所致，6例（19.4%）是穿透性机制造成的，通常是玻璃所致。超过四分之一（29.0%）的患者遭受了创伤性截肢。院前收缩压（SBP）中位数为100（四分位间距：80 - 110），院前心率（HR）中位数为101（四分位间距：77.0 - 122.3），PHTQ使用时间中位数为124分钟（四分位间距：47 - 243）。30例中有4例（13.3%）出现了与止血带相关的并发症。
该澳大利亚系列与北美民用PHTQ系列不同，穿透性创伤发生率较低，PHTQ使用时间较长。尽管如此，并发症发生率仍在已发表文献的范围内。鉴于海外研究在澳大利亚背景下的可转移性有限这一担忧，表明需要持续进行审核。
