Kashuk J L, Moore E E, Millikan J S, Moore J B
J Trauma. 1982 Aug;22(8):672-9. doi: 10.1097/00005373-198208000-00004.
Advances in prehospital emergency care have increased the numbers of patients arriving at the hospital with immediate life-threatening trauma. This is a review of our recent 6-year experience with 161 major abdominal vascular injuries in 123 patients. The distribution by injury site and respective mortality were: 18, aortic (56%); 39, aortic branch (37%); 51, inferior vena cava (39%); 30, inferior vena cava branch (45%); and 23, portal venous system (39%). The overall death rate was 37%. Forty-six patients presented with unobtainable blood pressure and 19 (41%) survived. Left thoracotomy and temporary aortic occlusion were required in the resuscitation of 45 patients; when applied in the emergency department the salvage rate was 7%, and in the operating room, 35%. Forty-four patients had more than one major vascular injury and 17 (39% recovered, compared to a survival rate of 76% with single vascular trauma. Others have emphasized that most deaths from major abdominal vascular injury are a result of hemorrhage. In our study although 89% of mortality was due to bleeding, half occurred after control of the major bleeding sites. These findings suggest that coagulopathy, hypothermia, and acidosis are complicating factors which demand as much attention by the surgeon as the initial resuscitation and operative control classically emphasized.
院前急救护理的进展使得送达医院的有即刻危及生命创伤的患者数量有所增加。本文回顾了我们最近6年里123例患者发生的161例严重腹部血管损伤的经验。按损伤部位及各自的死亡率分布如下：主动脉损伤18例（56%）；主动脉分支损伤39例（37%）；下腔静脉损伤51例（39%）；下腔静脉分支损伤30例（45%）；门静脉系统损伤23例（39%）。总体死亡率为37%。46例患者就诊时血压测不出，其中19例（41%）存活。45例患者在复苏过程中需要行左胸切开术及临时主动脉阻断；在急诊科应用时挽救率为7%，在手术室应用时挽救率为35%。44例患者有一处以上主要血管损伤，其中17例（39%）康复，而单一血管创伤的存活率为76%。其他人强调，大多数严重腹部血管损伤导致的死亡是出血所致。在我们的研究中，虽然89%的死亡是由于出血，但半数发生在主要出血部位得到控制之后。这些发现表明，凝血功能障碍、体温过低和酸中毒是复杂的因素，外科医生在重视传统上强调的初始复苏和手术控制的同时，也需要同样关注这些因素。
