加沙平民的创伤护理：法国军事人道主义任务的关键经验教训。

Trauma care of Gazan civilians: Key lessons from the French military humanitarian mission.

作者信息

Boye Matthieu, Py Nicolas, Paris Raphaël, Prunet Bertrand, Sarda Antoine, Lamblin Antoine, Chiron Paul, Martin Edouard

机构信息

From the Department of Anesthesia and Intensive Care (M.B., R.P., A.L., E.M.), Laveran Military Training Hospital, Marseille; Department of Anesthesia and Intensive Care (N.P.), Begin Military Training Hospital, Saint-Mandé; Department of Anesthesia and Intensive Care (B.P.), Princess Grace Hospital, Monaco; École du Val-de-Grâce (B.P., A.L.), French Military Medical Service Academy, Paris; Medical Center of the 3rd Combat Helicopter Regiment (A.S.), Etain, France; and Department of Urology (P.C.), Begin Military Training Hospital, Saint-Mandé, France.

出版信息

J Trauma Acute Care Surg. 2025 Aug 1;99(3S Suppl 1):S99-S105. doi: 10.1097/TA.0000000000004720. Epub 2025 Jun 30.

DOI:10.1097/TA.0000000000004720

PMID:40587368

Abstract

BACKGROUND

Following the attacks on October 7, 2023, Israel launched a high-intensity air and ground offensive in the Gaza Strip. In late November 2023, France led a humanitarian mission by deploying a Mistral-class landing helicopter dock with enhanced medical-surgical capabilities, positioned in Egypt near Rafah. This study aimed to describe the challenges of a humanitarian trauma mission in a modern conflict by analyzing the activity aboard the French landing helicopter dock, named DIXMUDE.

METHODS

This retrospective cohort study included all civilian patients admitted to the DIXMUDE for war-related physical trauma.

RESULTS

During the mission, 124 civilian patients were admitted to the DIXMUDE, 94 of whom sustained war-related physical injuries. Pediatric patients (younger than 15 years) represented 42% of the casualties (40 of 94 patients). Explosions were the primary cause of injury (95%). The median Injury Severity Score was 10, with a predominance of severe limb injuries. Nearly 80% of the victims had undergone damage-control surgery in Gaza before admission, and 50% required surgical reassessment on the DIXMUDE. Moreover, 171 war trauma procedures were performed, primarily orthopedic surgeries (54%). General anesthesia was used in the majority of cases (80%), with combined general and regional anesthesia in 19%. Pediatric surgical cases constituted 40%, with 20% of cases involving children younger than 10 years. Key challenges in trauma care included managing severe pain (37 of 94 patients [39%]), wound infections (20 of 94 patients [21%]) often associated with antimicrobial resistance (65%), and blood management requiring transfusions (13 of 94 patients [14%]).

CONCLUSION

The challenges of humanitarian war trauma missions require up-to-date skills in pediatrics, infectious diseases, and rehabilitation, including acute pain management and blood management.

LEVEL OF EVIDENCE

Therapeutics/Care Management; Level IV.

摘要

背景

2023年10月7日袭击事件后，以色列在加沙地带发动了高强度的空袭和地面攻势。2023年11月下旬，法国领导了一次人道主义任务，部署了一艘具备增强型外科手术能力的西北风级两栖攻击舰，停泊在埃及靠近拉法的地方。本研究旨在通过分析法国两栖攻击舰“迪克斯莫德号”上的活动，描述现代冲突中人道主义创伤任务面临的挑战。

方法

这项回顾性队列研究纳入了所有因战争相关身体创伤而被收治到“迪克斯莫德号”上的平民患者。

结果

在任务期间，124名平民患者被收治到“迪克斯莫德号”上，其中94人遭受了与战争相关的身体伤害。儿科患者（15岁以下）占伤亡人数的42%（94名患者中的40名）。爆炸是受伤的主要原因（95%）。损伤严重程度评分中位数为10分，主要是严重的肢体损伤。近80%的受害者在入院前已在加沙接受了损伤控制手术，50%的患者需要在“迪克斯莫德号”上进行手术重新评估。此外，共进行了171例战争创伤手术，主要是骨科手术（54%）。大多数病例（80%）使用了全身麻醉，19%的病例采用了全身麻醉与区域麻醉相结合的方式。儿科手术病例占40%，其中20%的病例涉及10岁以下儿童。创伤护理中的主要挑战包括处理严重疼痛（94名患者中的37名[39%]）、伤口感染（94名患者中的20名[21%]），伤口感染常与抗菌药物耐药性（65%）相关，以及需要输血的血液管理（94名患者中的13名[14%]）。