急诊科对严重腹部创伤患者的开腹手术:韩国一家地区创伤中心的回顾性研究

Yu Jin Lee, Soon Tak Jeong, Joongsuck Kim, Kwanghee Yeo, Ohsang Kwon, Kyounghwan Kim, Sungjin Park, Jihun Gwak, Wu Seong Kang
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引用次数: 0

摘要

目的:严重的腹部损伤往往需要立即进行临床评估和手术干预,以防止出现危及生命的并发症。在济州地区创伤中心,我们制定了在创伤室进行急诊科(ED)开腹手术的方案。我们对死亡率和从入院到急诊科开腹手术所需的时间进行了调查。方法:我们回顾了本中心创伤数据库在 2020 年 1 月至 2022 年 12 月期间记录的数据,并确定了因腹部创伤而接受开腹手术的患者。在创伤室或急诊室进行的开腹手术被归类为急诊室开腹手术,而在手术室(OR)进行的开腹手术被称为手术室开腹手术。在需要快速止血的病例中,急诊室开腹手术被恰当地执行。结果:2020 年 1 月至 2022 年 12 月,我院收治的 105 名创伤患者接受了急诊开腹手术。其中,6 名患者(5.7%)接受了急诊开腹手术。急诊室开腹手术的死亡率为66.7%(6名患者中有4名),明显高于手术室开腹手术的死亡率(17.1%,99名患者中有18名,P=0.006)。所有接受急诊室开腹手术的患者都接受了损伤控制开腹手术。与手术室开腹手术组(104 分钟;IQR,88-151 分钟;P<0.001)相比,急诊室开腹手术组从入院到首次开腹手术的时间明显更短(28.5 分钟;四分位数间距 [IQR],14-59 分钟)。在急诊室开腹手术后存活的两名患者肠系膜大量出血,并成功结扎。另外四名患者则因肝裂伤、肾破裂、脾损伤和胰腺撕脱而死亡。结论虽然急诊室开腹手术的死亡率较高,但入院到急诊室开腹手术之间的时间明显短于手术室开腹手术。值得注意的是,肠系膜大出血可通过急诊室开腹手术得到有效控制。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Emergency department laparotomy for patients with severe abdominal trauma: a retrospective study at a single regional trauma center in Korea
Purpose: Severe abdominal injuries often require immediate clinical assessment and surgical intervention to prevent life-threatening complications. In Jeju Regional Trauma Center, we have instituted a protocol for emergency department (ED) laparotomy at the trauma bay. We investigated the mortality and time taken from admission to ED laparotomy. Methods: We reviewed the data recorded in our center’s trauma database between January 2020 and December 2022 and identified patients who underwent laparotomy because of abdominal trauma. Laparotomies that were performed at the trauma bay or the ED were classified as ED laparotomy, whereas those performed in the operating room (OR) were referred to as OR laparotomy. In cases that required expeditious hemostasis, ED laparotomy was performed appropriately. Results: From January 2020 to December 2022, 105 trauma patients admitted to our hospital underwent emergency laparotomy. Of these patients, six (5.7%) underwent ED laparotomy. ED laparotomy was associated with a mortality rate of 66.7% (four of six patients), which was significantly higher than that of OR laparotomy (17.1%, 18 of 99 patients, P=0.006). All the patients who received ED laparotomy also underwent damage control laparotomy. The time between admission to the first laparotomy was significantly shorter in the ED laparotomy group (28.5 minutes; interquartile range [IQR], 14–59 minutes) when compared with the OR laparotomy group (104 minutes; IQR, 88–151 minutes; P<0.001). The two patients who survived after ED laparotomy had massive mesenteric bleeding, which was successfully ligated. The other four patients, who had liver laceration, kidney rupture, spleen injury, and pancreas avulsion, succumbed to the injuries. Conclusions: Although ED laparotomy was associated with a higher mortality rate, the time be-tween admission and ED laparotomy was markedly shorter than for OR laparotomy. Notably, major mesenteric hemorrhages were effectively controlled through ED laparotomy.
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