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创伤性下腔静脉损伤患者血管内治疗的作用。

Role of endovascular management on outcomes in patients with traumatic inferior vena cava injuries.

机构信息

Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, Tucson, USA.

Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, Tucson, USA.

出版信息

Am J Surg. 2024 Dec;238:115836. doi: 10.1016/j.amjsurg.2024.115836. Epub 2024 Jul 11.

Abstract

INTRODUCTION

The aim of this study was to examine the association between the injury mechanism and repair type with outcomes in patients with traumatic inferior vena cava injuries.

METHODS

This is a retrospective analysis of the ACS-TQIP database (2017-2020), including patients with traumatic IVC injuries. Patients were stratified by injury mechanism and type of repair and compared.

RESULTS

Out of 1334 patients, 5 ​% underwent endovascular repair while 95 ​% had an open procedure. Overall, 74.7 ​% sustained a penetrating injury. On multivariable regression analysis, the type of repair was not associated with mortality and morbidity for patients with penetrating injuries. However, among patients with blunt injuries, endovascular repair was associated with lower odds of in-hospital mortality (aOR:0.35, p ​= ​0.020) and non-venous thromboembolism (VTE) morbidity (aOR:0.41, p ​= ​0.015), and higher odds of VTE complications (aOR:6.74, p ​< ​0.001).

CONCLUSIONS

Although the type of repair did not impact morbidity and mortality in patients with penetrating injuries, endovascular repair was identified as the only modifiable predictor of reduced non-VTE morbidity and mortality in patients with blunt injuries.

摘要

简介

本研究旨在探讨创伤性下腔静脉损伤患者的损伤机制与修复类型与结局的关系。

方法

这是对 ACS-TQIP 数据库(2017-2020 年)的回顾性分析,包括创伤性 IVC 损伤患者。根据损伤机制和修复类型对患者进行分层,并进行比较。

结果

在 1334 名患者中,5%接受了血管内修复,95%接受了开放手术。总体而言,74.7%的患者发生穿透性损伤。多变量回归分析显示,对于穿透性损伤患者,修复类型与死亡率和发病率无关。然而,对于钝性损伤患者,血管内修复与院内死亡率降低(aOR:0.35,p=0.020)和非静脉血栓栓塞症(VTE)发病率降低(aOR:0.41,p=0.015)相关,而 VTE 并发症的发生率升高(aOR:6.74,p<0.001)。

结论

虽然修复类型对穿透性损伤患者的发病率和死亡率没有影响,但血管内修复被确定为唯一可改变的预测因素,可降低钝性损伤患者的非 VTE 发病率和死亡率。

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