在资源有限的情况下,下肢血管创伤的流行病学和治疗的观点

Dawit Gebregiorgis, B. Nega, N. Seyoum
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摘要

背景:肢体血管损伤是创伤后肢体丧失和潜在可预防死亡的主要原因之一。尽管这是一项重大挑战,特别是在创伤中心不太建立的国家,但早期诊断和干预对于取得更好的结果非常重要。本研究的目的是描述埃塞俄比亚环境中四肢血管创伤的流行病学、管理策略和结果。方法:对2015年6月至2020年5月在提库尔安贝萨专科医院(TASH)住院治疗的所有四肢血管创伤患者进行回顾性观察研究。结果:共纳入85例肢体血管损伤患者,以男性为主(90.6%)。平均年龄27±9岁。89.4%的四肢血管损伤为穿透性损伤。大多数伤害是由刀/利器(40%)、子弹(29.4%)和道路交通事故(17.7%)造成的。肱动脉是最常见的血管损伤,占36.5%,其次是股动脉,占22.4%。最常见的血管损伤类型为完全横断(74.1%)、撕裂伤(15.3%)和部分横断(8.2%)。最常用的血管重建方法是反向介入静脉移植物,占45.9%。其他方法为结扎止血(20%)、端到端吻合术一期修复(17.7%)、一期简单修复(15.3%)和静脉贴片(1.2%)。尽管出现时间晚(>6小时)的比例为67.1%,但残肢保留率为91.8%。结论:暴力和道路交通事故是造成血管损伤的主要原因。通过改善卫生政策、实施紧急门诊系统以及提供血管服务和更好的培训中心,可以减轻这种伤害造成的肢体丧失和死亡率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A perspective of extremity vascular trauma epidemiology and its management in a resource limited set up
Background: Extremity vascular injuries are one of the major causes of limb loss and potentially preventable deaths after trauma. Although it is a major challenge, especially in countries with a less established trauma center, early diagnosis, and intervention are important for a better outcome. The aim of this study was to describe the epidemiology, management strategies, and outcomes of extremity vascular trauma in the Ethiopian setting. Methods: A retrospective observational study was conducted among all extremity vascular trauma patients who were admitted and treated at Tikur Anbessa Specialized Hospital (TASH) Between June 2015 and May 2020. Result: A total of 85 patients with extremity vascular trauma, predominantly male (90.6%), were included in the study. The mean age was 27 ± 9 years. Penetrating trauma caused 89.4% of extremity vascular injuries. The majority of the injuries are caused by stab/sharp (40%), bullet (29.4%) and road traffic accidents (17.7%). The brachial artery was the commonest vessel injured accounting for 36.5% followed by femoral artery injury of (22.4%). The commonest types of vascular injuries were complete transection (74.1%), laceration (15.3%), and partial transection (8.2%). The most commonly used method of vascular reconstruction was reverse interposition venous graft accounting for 45.9%. Other methods were ligation & hemostasis (20%), primary repair with End-to-End Anastomosis (17.7%), primary simple repair (15.3%), and venous patch (1.2%). A limb salvage rate of 91.8% was achieved despite a 67.1% of late presentation (>6 hours). Conclusion: Vascular injuries are mainly due to violence and road traffic accidents. Limb loss and mortality due to this injury can be mitigated by improving health policies, implementing emergency ambulatory systems, and provision of vascular services with better training centers.
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