Eachempati S R, Vaslef S N, Sebastian M W, Reed R L
Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
J Trauma. 1998 Dec;45(6):997-1004. doi: 10.1097/00005373-199812000-00004.
Blunt vascular injuries to the head and neck (BHVI) represent some of the most devastating and morbid injuries seen by a trauma surgeon. This series reviewed the experience of a single institution to determine if diagnostic and therapeutic guidelines can be established for these uncommon injuries. In particular, the utility of anticoagulation in the treatment of these injuries is examined.
The institutional trauma registry of a single state-designated Level I trauma center was examined for patients with BHVI. Patients were identified and their charts reviewed individually with regard to multiple data points including the type of injury, its presentation, the treatment of the injury, and the functional outcome of the patient.
Twenty-nine BHVI in 23 patients were reviewed from 1989 to 1997. No mortalities were noted. Among the injuries noted were 14 internal carotid artery dissections and 8 carotid artery tears. Thirteen patients had accompanying closed head injuries. Ten patients were diagnosed after an abnormal neurologic examination, and eight others were diagnosed after having carotid canal fractures. Heparin was started within 48 hours of injury in 4 patients (17%) and was used in a total of 12 patients (52%). No patient worsened neurologically after diagnosis independent of the use of heparin. Thirteen patients (57%) had no or minimal deficits upon discharge.
BHVI represent a serious cause of morbidity in the patient with multiple injuries. Patients with closed head injuries and carotid canal fractures appear most at risk. A multicenter, randomized trial involving antiplatelet therapy, full systemic anticoagulation, or observation with a long-term functional assessment is indicated to determine the optimal management of these injuries.
头颈部钝性血管损伤（BHVI）是创伤外科医生所见的最具毁灭性和致残性的损伤之一。本系列回顾了单一机构的经验，以确定是否可为这些罕见损伤制定诊断和治疗指南。特别是，研究了抗凝在这些损伤治疗中的作用。
检查了一个单一的州指定一级创伤中心的机构创伤登记处，以查找患有BHVI的患者。识别出患者，并针对包括损伤类型、表现、损伤治疗以及患者功能结局在内的多个数据点，分别查阅他们的病历。
1989年至1997年期间，对23例患者的29处BHVI进行了回顾。未观察到死亡病例。记录的损伤包括14例颈内动脉夹层和8例颈动脉撕裂。13例患者伴有闭合性头部损伤。10例患者在神经系统检查异常后被诊断，另外8例在发生颈动脉管骨折后被诊断。4例患者（17%）在受伤后48小时内开始使用肝素，共有12例患者（52%）使用了肝素。无论是否使用肝素，诊断后均无患者神经功能恶化。13例患者（57%）出院时无或仅有轻微功能缺损。
BHVI是多发伤患者发病的严重原因。闭合性头部损伤和颈动脉管骨折的患者似乎风险最高。需要进行一项多中心、随机试验，涉及抗血小板治疗、全身充分抗凝或观察并进行长期功能评估，以确定这些损伤的最佳治疗方法。
