THE IMPORTANCE OF PROMPT TRANSPORT IN SALVAGE OF PATIENTS WITH PENETRATING HEART WOUNDS
THE IMPORTANCE OF PROMPT TRANSPORT IN SALVAGE OF PATIENTS WITH PENETRATING HEART WOUNDS
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DOI：
10.1097/00005373-198206000-00001
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发表时间：
1982-01-01
影响因子：
--
通讯作者：
FISCHER, RP
中科院分区：
文献类型：
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作者：
GERVIN, AS;FISCHER, RP
心脏穿透伤患者转运前的现场稳定对死亡率的影响尚不清楚。这项回顾性研究比较了心脏穿透伤后立即转运并接受最小治疗的患者与在现场接受长期稳定治疗的患者。在1979年至1981年的研究期间，在我们的机构看到了23例心脏穿透伤患者。总死亡率为78%。43%的病人由于广泛的解剖损伤或救护车到达前的时间过长而无法挽救。救护车到达时，五十六%的人还活着，收缩压大于90毫米汞柱。所有的病人都是在从我们机构快速运送的10分钟内受伤的。大约一半的患者采用“勺和运行”技术进行治疗，最小限度地进行现场治疗。从救护车到达到最终手术矫正的延迟时间不到9分钟。其余患者接受了广泛的现场稳定尝试治疗，从救护车到达到最终治疗延迟25分钟或更长时间（平均40分钟）。具有潜在可挽救损伤的患者的存活率为38%。在这组患者中，如果运输延迟最小化，则挽救率为80%。相比之下，没有患者在现场复苏伴随延长院前延迟生存。这些数据表明，迅速运送到医院，而不尝试现场复苏，为心脏穿透伤患者提供了更好的生存机会。
The impact on mortality of stabilization in the field before transport of patients with penetrating heart injuries is unknown. This retrospective study compares patients promptly transported with minimal therapy after penetrating cardiac injuries with such patients who had received prolonged attempts at stabilization in the field. During the period of study from 1979 to 1981 23 patients with penetrating wounds of the heart were seen at our institution. The overall mortality was 78%. Forty-three per cent of patients were not salvageable on the basis of extensive anatomic injury or excessive time delays before ambulance arrival. Fifty-six per cent were alive at the time of ambulance arrival with systolic blood pressures of greater than 90 mm Hg. All patients were injured within 10 minutes' rapid transport time from our institution. Approximately one half the patients were treated with ‘scoop and run’technique with minimal in-field treatment. Delay from the arrival of the ambulance until definitive surgical correction was less than 9 minutes. The remaining patients were treated with extensive in-field attempts at stabilization with a delay of 25 minutes or more from ambulance arrival until definitive treatment (mean, 40 minutes). Patients with potentially salvageable injuries had a survival rate of 38%. In this group of patients, a salvage rate of 80% was achieved if transport delays were minimized. In contrast, no patients in whom field resuscitation with concomitant prolonged prehospital delay survived. These data suggest that prompt transport to the hospital without attempts at field resuscitation provides a better chance for survival among patients with penetrating heart wounds.