股腘血管损伤的预后因素:手术决定至关重要

IF 0.8 Q4 PERIPHERAL VASCULAR DISEASE
Adenauer Marinho de Oliveira Góes Junior, Fernanda Beatriz Araújo de Albuquerque, Matheus Oliveira Feijó, Flávia Beatriz Araújo de Albuquerque, Luciana Roberta do Vale Corrêa, Mariseth Carvalho de Andrade
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引用次数: 0

摘要

背景下肢经常发生血管损伤,但目前尚不清楚是哪些因素导致了不良的临床结果。目的探讨股腘肌损伤患者的临床特点、创伤机制和治疗方法,并确定导致不良结果的因素。方法回顾性分析2017 ~ 2021年收治患者的病历资料。评估以下数据:性别、年龄、到达医院的距离、创伤机制、低血容量性休克、附加损伤、血管损伤的治疗、是否需要筋膜切开术、不适当的术中决策和损伤严重程度评分。需要手术再干预、截肢和死亡被定义为不良结果。进行了单因素、双因素和逻辑回归分析。结果本组94例患者;83%是男性;平均年龄30.8岁;动、静脉合并损伤占57.5%;以股浅血管为主(61.7%)。穿透机制占主导地位(80.9%)。静脉移植治疗动脉损伤最多(59.6%),结扎治疗静脉损伤最多(81.4%)。在15%的病例中,发现了不适当的手术决定;最常使用同侧大隐静脉进行动脉重建。不良结局发生率为44.7%:21.3%的患者需要再次手术干预,25.5%的患者需要截肢,9.5%的患者死亡。结论这些损伤主要以年轻男性、枪伤受害者为主。股骨浅血管损伤最严重;同时发生非血管性损伤,以骨折为主。不恰当的手术决定使再干预的需求增加了34倍。需要进行筋膜切开术,存在骨折/脱位,钝性创伤机制和腘动脉损伤增加了截肢的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prognostic factors for femoropopliteal vascular injuries: surgical decisions matter
Abstract Background Lower limbs are frequently involved in vascular trauma, but it is still not clear which factors lead to unfavorable clinical outcomes. Objectives To determine the clinical profile of patients with femoropopliteal injuries, the trauma mechanisms, and treatment and identify which factors led to unfavorable outcomes. Methods A retrospective study based on the medical records of patients treated from 2017 to 2021. The following data were assessed: sex, age, distance to reach the hospital, trauma mechanism, hypovolemic shock, additional injuries, treatment of vascular injuries, whether fasciotomy was needed, inappropriate intraoperative decisions, and injury severity score. Need for surgical reintervention, amputation, and death were defined as unfavorable outcomes. Univariate, bivariate, and logistic regression analyses were conducted. Results The sample comprised 94 patients; 83% were men; mean age was 30.8 years; combined arterial and venous injuries prevailed (57.5%); and superficial femoral vessels were the most affected (61.7%). Penetrating mechanisms prevailed (80.9%). Arterial injuries were most frequently treated with venous graft (59.6%) and venous injuries underwent ligation (81.4%). In 15% of cases, inappropriate surgical decisions were detected; most often use of the ipsilateral great saphenous vein for arterial reconstruction. Unfavorable outcomes occurred in 44.7%: surgical reintervention was necessary in 21.3% and limb amputation in 25.5%, while 9.5% of the patients died. Conclusions These injuries mainly involved young men, victims of gunshot wounds. Superficial femoral vessels were the most injured; concomitant non-vascular trauma was frequent, mainly fractures. Inappropriate surgical decisions increased the need for reinterventions by 34 times. Need for fasciotomy, presence of fracture/dislocation, blunt trauma mechanism, and popliteal artery injury increased the risk of amputation.
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来源期刊
Jornal Vascular Brasileiro
Jornal Vascular Brasileiro Medicine-Cardiology and Cardiovascular Medicine
CiteScore
1.20
自引率
0.00%
发文量
57
审稿时长
20 weeks
期刊介绍: The Jornal Vascular Brasileiro is editated and published quaterly to select and disseminate high-quality scientific contents concerning original research, novel surgical and diagnostic techniques, and clinical observations in the field of vascular surgery, angiology, and endovascular surgery. Its abbreviated title is J. Vasc. Bras., which should be used in bibliographies, footnotes and bibliographical references and strips.
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