Wall M J, Pepe P E, Mattox K L
Cora and Webb Mading Department of Surgery, Baylor College of Medicine, Houston, TX 77030.
J Trauma. 1994 Jan;36(1):131-4.
Patients with injuries severe enough to require cardiopulmonary resuscitation (CPR) have a dismal prognosis. Time to surgical intervention is a major determinant of outcome in moribund trauma patients who have a potential for survival. With the exception of endotracheal intubation during evacuation to surgical intervention, no other usual prehospital procedures have been validated to affect outcome in such cases of extremis. This is a report of a case in which resuscitative surgical techniques were extended successfully to the prehospital environment. The patient was a 30-year-old man in extremis after a stab wound to the left chest. Estimating a transport time of 15 minutes, a physician riding with the emergency medical service (EMS) crews elected to perform a resuscitative thoracotomy. Following digital aortic compression, the patient regained both blood pressure and consciousness by the time of arrival at the trauma center. A left lower lobectomy was then performed in the operating room. The patient recovered fully and was discharged home in 21 days, neurologically intact. Four years later, the patient was alive, healthy, and working. This report demonstrates the feasibility of prehospital thoracotomy and raises provocative issues regarding future intense surgical involvement in prehospital care.
伤势严重到需要进行心肺复苏（CPR）的患者预后不佳。对于有存活可能的濒死创伤患者，手术干预的时机是决定预后的主要因素。除了在转运至手术干预过程中进行气管插管外，尚无其他常规院前程序被证实能在此类极端情况下影响预后。本文报告了一例成功将复苏性手术技术扩展至院前环境的病例。患者为一名30岁男性，左胸被刺伤后处于濒死状态。预计转运时间为15分钟，随紧急医疗服务（EMS）人员一同前往的一名医生决定进行复苏性开胸手术。在进行手指主动脉按压后，患者在抵达创伤中心时恢复了血压和意识。随后在手术室进行了左下肺叶切除术。患者完全康复，21天后出院，神经功能完好。四年后，患者健在、健康且仍在工作。本报告证明了院前开胸手术的可行性，并引发了关于未来在院前护理中加强手术介入的一些引人深思的问题。
