Stiles Q R, Cohlmia G S, Smith J H, Dunn J T, Yellin A E
Am J Surg. 1985 Jul;150(1):132-40. doi: 10.1016/0002-9610(85)90022-4.
Thirty-five patients had surgery for injuries of the aorta at the Los Angeles County-USC Medical Center over a 4 1/2 year period. There were 27 survivors. The principles of management were to operate without delay if there was evidence of continued bleeding after initial fluid replacement as occurred in 11 patients. For the 24 patients who became stable after initial resuscitation, a more deliberate plan of management was used. Blood pressure was carefully monitored and controlled to avoid hypertension. Priorities for associated injuries were established and in several cases, they took treatment precedence over the aortic injury. Delay was sometimes necessary to utilize the more experienced personnel. In no instance did a stabilized patient hemorrhage during the delay. The most common injury seen was a blunt disruption of the proximal descending aorta. The details of the operative technique for this injury have been reported herein, along with a justification for not using either pump bypass or shunt to perfuse the distal aorta during the period of aortic cross-clamping.
在4年半的时间里，有35名患者在洛杉矶县南加州大学医学中心接受了主动脉损伤手术。其中27人存活。治疗原则是，如果在最初补液后仍有持续出血迹象（11名患者出现这种情况），应立即进行手术。对于最初复苏后病情稳定的24名患者，采用了更为审慎的治疗方案。密切监测并控制血压以避免高血压。确定了相关损伤的治疗优先级，在某些情况下，这些损伤的治疗优先于主动脉损伤。有时为了利用更有经验的人员而有必要延迟治疗。在延迟治疗期间，没有一例病情稳定的患者发生出血。最常见的损伤是近端降主动脉钝性断裂。本文报告了该损伤的手术技术细节，以及在主动脉交叉钳夹期间不使用泵旁路或分流来灌注远端主动脉的理由。
