肋骨骨折手术固定(SSRF)术中血胸清除:技术是否影响预后?
Evacuation of hemothorax during SSRF: Does the technique influence the outcome?
作者
作者单位
- Thoracic Surgery Unit., Dept. Surgery, Aladar Petz University Teaching Hospital, Gyor Vasvari Pal str.2-4., Hungary; Hungarian Air Ambulance Nonprofit Ltd., Budaors Legimento str.8., Hungary; Doctoral School, University of Pecs, Szigeti str. 12., Pecs 7624, Hungary. Electronic address: david.sutori@petzkorhaz.hu.
- Division of Trauma and Acute Care Surgery, Intermountain Medical Center, Murray, UT 84107, USA.
- Thoracic Surgery Unit., Dept. Surgery, Aladar Petz University Teaching Hospital, Gyor Vasvari Pal str.2-4., Hungary; Operational Medicine Dept., Medical Skill and Innovation Center Medical School, University of Pecs, Szigeti str.12., Pecs 7624, Hungary.
- Department of Mathematics and Computational Sciences, Szechenyi Istvan University Egyetem sqr.1, Gyor 9026, Hungary.
- Semmelweis University, Department of Otorhinolaryngology, Head and Neck Surgery, Szigony str.36, Budapest, Hungary.
- Thoracic Surgery Unit., Dept. Surgery, Aladar Petz University Teaching Hospital, Gyor Vasvari Pal str.2-4., Hungary.
- Department of Surgery, University of Nebraska Medical Center, 983280 Omaha, USA.
- Hungarian Air Ambulance Nonprofit Ltd., Budaors Legimento str.8., Hungary; Gottsegen National Cardiovascular Center, Haller str.29., Budapest, 1096 Hungary.
- St Francis Hospital and Medical Center, University of Connecticut School of Medicine, Hartford, CT, USA.
- Chest Wall Injury Society, 1182 Hudson Avenue Salt Lake City, UT 84106, USA.
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
摘要
中文
多种外科方案建议在肋骨骨折手术固定(SSRF)合并血胸(HTX)时进行胸腔探查。本研究旨在比较 SSRF 术中盲法血胸清除与直视下血胸冲洗的患者预后。本研究对胸壁损伤学会(CWIS)成员贡献的胸外伤国际数据库(CIID)中前瞻性收集的数据进行回顾性分析。设立两个队列:组 VATS(SSRF 联合电视胸腔镜手术)与组 IOPI(SSRF 联合术中盲法胸腔灌洗(IOPI))。主要终点为 SSRF 术后胸管留置天数。次要终点包括肺炎、死亡率、重症监护病房住院时间(ICULOS)、住院时间(HLOS)、30 天再入院率及机械通气天数。共纳入 276 例患者(VATS 组 n=129;IOPI 组 n=147)。VATS 组胸管留置时间更短(VATS:0[0–2],IOPI:3[2–5];p<0.001),而 IOPI 组住院时间更短(VATS:10.5[7–15],IOPI:7[5–10];p<0.001)。VATS 组机械通气使用更频繁(VATS:n=83/129,IOPI:n=21/147;p<0.001),但 IOPI 组通气持续时间更长(VATS:1[1],IOPI:4[2–10];p<0.001)。死亡率(p=0.417)、肺炎(p=0.842)、再入院率(p=0.107)及 ICU 入住患者的 ICU 住院时间(p=0.953)组间无差异。在校正损伤严重程度和肺挫伤负荷后,VATS 仍与更短的胸管留置时间独立相关,而血胸清除技术与住院时间或 ICU 住院时间无独立相关性。SSRF 术中应用 VATS 与更短的胸管留置时间相关,经校正损伤严重程度和肺挫伤负荷后该相关性仍显著。然而,两种技术在更广泛的临床预后方面相当。治疗/管理类研究;Level IV 证据。
English
Various surgical protocols suggest the need for chest cavity exploration during surgical stabilization of rib fractures (SSRF) in the presence of a hemothorax (HTX). The aim of this study is to determine the outcome of patients who underwent SSRF with blind HTX evacuation vs. HTX washout under visual inspection. This is a retrospective analysis of prospectively collected data from the Chest Injury International Database (CIID), a data repository of the Chest Wall Injury Society (CWIS) contributing members. Two cohorts were created: group VATS (SSRF with Video-Assisted Thoracic Surgery (VATS)) and group IOPI (SSRF with blind intra-operative pleural irrigation (IOPI)). The primary endpoint was chest tube days after SSRF. Secondary endpoints were pneumonia, mortality, Intensive Care Unit length of stay (ICULOS), hospital length of stay (HLOS), 30-day readmission, and mechanical ventilation days. A total of 276 patients were included (VATS n = 129; IOPI n = 147). Chest tube duration was shorter in the VATS group (VATS: 0[0-2], IOPI: 3[2-5]; p < 0.001), while hospital length of stay was shorter in the IOPI group (VATS: 10.5[7-15], IOPI 7[5-10]; p < 0.001). Mechanical ventilation was more frequent in the VATS group (VATS: n = 83/129, IOPI: n = 21/147; p < 0.001), whereas ventilation duration was longer in the IOPI group (VATS: 1[1], IOPI: 4[2-10]; p < 0.001). Mortality (p = 0.417), pneumonia (p = 0.842), readmission (p = 0.107), and ICU length of stay among ICU-admitted patients (p = 0.953) did not differ between groups. After adjustment for injury severity and pulmonary contusion burden, VATS remained independently associated with shorter chest tube duration, whereas hemothorax evacuation technique was not independently associated with hospital or ICU length of stay. The use of VATS during SSRF was associated with shorter chest tube duration, and this association remained significant after adjustment for injury severity and pulmonary contusion burden. However, broader clinical outcomes were comparable between techniques. Therapeutic / Care Management; Level IV.
分类与指标
- 研究类型
- 临床研究
- 病种
- 气胸·外伤·胸壁
- JCR 分区
- Q2
- 影响因子
- 2.4
- 新锐分区
- 3区