Tourniquet use for civilian extremity trauma
Tourniquet use for civilian extremity trauma
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DOI：
10.1097/ta.0000000000000747
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发表时间：
2015-08-01
影响因子：
3.4
通讯作者：
Demetriades, Demetrios
中科院分区：
文献类型：
--
作者：
Inaba, Kenji;Siboni, Stefano;Demetriades, Demetrios
背景与在军事环境中使用止血带不同的是，在民用部门，止血带的使用远没有那么统一。本研究的目的是探讨使用止血带治疗平民四肢创伤的预后。本研究回顾了2007年1月至2014年6月收治的因肢体损伤而需使用止血带的成人患者(18岁)。分析的主要结果是肢体丧失。次要结果包括死亡、住院时间和并发症。结果有87名患者符合纳入标准。平均年龄35.3岁，男性占90.8%，穿透伤占66.7%，损伤严重程度评分(ISS)中位数为6分。院前止血带占50.6%，急诊科占39.1%，手术室占10.3%。使用最多的是绞车式战斗应用止血带(67.8%)，其次是气动止血带(24.1%)和自制止血带(8.0%)。使用时间的中位数为75分钟(四分位数范围，91)，组间没有差异(p=0.547)。总体而言，80.5%的患者有血管损伤(70.1%的动脉损伤)，总共进行了99次肢体手术，其中包括15次截肢。14例截肢(93.3%)发生在现场或直接归因于组织损伤的程度，四肢毁损严重程度评分(MESS)中位数为7(四分位数范围，2)。在剩下的病人中，止血带是救命的，但很可能导致肢体丧失。7例患者出现了其他13种并发症，但无一直接归因于止血带的使用。结论在民用部门使用止血带与低并发症发生率有关。由于并发症发生率低，受益潜力大，积极使用这种潜在的挽救生命的干预措施是合理的。证据水平流行病学/预后研究，水平III。
BACKGROUND Unlike in the military setting, where the use of tourniquets has been well established, in the civilian sector their use has been far less uniform. The purpose of this study was to examine the outcomes associated with the use of tourniquets for civilian extremity trauma.STUDY DESIGN Adult (18 years) patients admitted to our institution with an extremity injury requiring tourniquet application from January 2007 to June 2014 were retrospectively reviewed. The primary outcome analyzed was limb loss. Secondary outcomes included death, hospital length of stay, and complications.RESULTS There were 87 patients who met inclusion criteria. Average age was 35.3 years, 90.8% were male, and 66.7% had penetrating injuries, with a median Injury Severity Score (ISS) of 6. Tourniquets were placed in the prehospital setting in 50.6%, in the emergency department in 39.1%, and in the operating room in 10.3% of patients. The windlass type Combat Application Tourniquet was the most commonly used type (67.8%), followed by a pneumatic system (24.1%) and self-made tourniquet (8.0%). The median duration of use was 75 minutes (interquartile range, 91) with no differences between groups (p = 0.547). Overall, 80.5% had a vascular injury (70.1% arterial), and a total of 99 limb operations were performed, including 15 amputations. Fourteen amputations (93.3%) occurred at the scene or were directly attributed to the extent of tissue damage with a median Mangled Extremity Severity Score (MESS) of 7 (interquartile range, 2). In the remaining patient, the tourniquet was lifesaving but likely contributed to limb loss. Seven patients sustained 13 other complications; however, none was directly attributed to tourniquet use.CONCLUSION Tourniquet use in the civilian sector is associated with a low rate of complications. With the low complication rate and high potential for benefit, aggressive use of this potentially lifesaving intervention is justified.LEVEL OF EVIDENCE Epidemiologic/prognostic study, level III.