Traumatic blunt thoracic aortic injury: a 10-year single-center retrospective analysis.
Traumatic blunt thoracic aortic injury: a 10-year single-center retrospective analysis.
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胸主动脉创伤性钝性损伤：10 年单中心回顾性分析
DOI：
10.1186/s13019-022-02094-0
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发表时间：
2022-12-23
影响因子：
1.6
通讯作者：
Cong, Ren
中科院分区：
文献类型：
--
作者：
Sun, Jingwei;Ren, Kai;Zhang, Liyun;Xue, Chao;Duan, Weixun;Liu, Jincheng;Cong, Ren
钝性胸主动脉损伤（BTAI）患者约80%在到达医院前死亡。大多数在最初受伤后幸存下来的人最终在没有得到适当治疗的情况下死亡。本研究分析并报告了近10年来单中心BTAI的治疗策略及早中期临床结果。本研究纳入了所有年龄≥ 18岁的BTAI住院患者。回顾性收集并分析临床资料、影像学表现及随访结果。Kaplan-Meier曲线和多因素Logistic回归分析比较幸存者和nonsurvivers.ResultsA共72例（57%男性）被诊断为BTAI，平均年龄为54.2 ± 9.1岁。损伤严重度评分为24.3 ± 18，I级BTAI 1（1.4%）、II级17（23.6%）、III级52（72.2%）和IV级2（2.8%）主动脉损伤。32例（44.4%）患者的主要病因为交通事故。大多数患者有创伤，37例（51.4%）肋骨骨折，60例（83.3%）患者接受胸主动脉腔内修复术（TEVAR），8例（11.1%）患者接受保守治疗，仅4例（5.6%）患者接受开放手术。总住院死亡率为12.5%。在多因素Logistic回归分析中，肌酐水平升高（P= 0.041）和高格拉斯哥昏迷量表（GCS）评分（P= 0.004）是住院死亡率的预测因素。中位随访期为57（28-87）个月。在随访期间，全因死亡率为5.6%，未报告与药物相关的死亡。3例患者（4.2%）需要二次手术，其中2例接受了腔内修复术。结论虽然TEVAR手术可能与术中或术后夹层破裂或严重并发症的治疗III级BTAI，发病率仅为8.9%。尽管如此，TEVAR手术仍然是治疗II级或III级BTAI的安全可行的方法，应首先考虑手术治疗。急诊科高GCS评分和肌酐水平升高与住院死亡率密切相关。年轻患者在TEVAR后需要长期随访。
BackgroundApproximately 80% of patients with blunt thoracic aortic injury (BTAI) die before reaching the hospital. Most people who survive the initial injury eventually die without appropriate treatment. This study analyzed and reported the treatment strategy of a single center for BTAI in the last 10 years and the early and middle clinical results.MethodsThis retrospective study included patients diagnosed with BTAI at Xijing Hospital from 2013 to 2022. All inpatients with BTAI aged ≥ 18 years were included in this study. The clinical data, imaging findings, and follow-up results were retrospectively collected and analyzed. The Kaplan–Meier curve and multivariate logistic regression were used to compare survivors and nonsurvivors.ResultsA total of 72 patients (57% men) were diagnosed with BTAI, with a mean age of 54.2 ± 9.1 years. The injury severity score was 24.3 ± 18, with Grade I BTAI1 (1.4%), Grade II 17 (23.6%), Grade III 52 (72.2%), and Grade IV 2 (2.8%) aortic injuries. Traffic accidents were the main cause of BTAI in 32 patients (44.4%). Most patients had trauma, 37 had rib fractures (51.4%), Sixty patients (83.3%) underwent thoracic endovascular aortic repair (TEVAR) surgery, eight (11.1%) underwent conservative treatment, and only four (5.6%) underwent open surgery. The overall hospitalization mortality was 12.5%. In multivariate logistic regression, elevated creatinine levels (P= 0.041) and high Glasgow coma scale (GCS) score (P= 0.004) were the predictors of hospital mortality. The median follow-up period was 57 (28–87) months. During the follow-up period, all-cause mortality was 5.6% and no aortic-related deaths were reported. Three patients (4.2%) needed secondary surgery and two of them underwent endovascular repair.ConclusionAlthough TEVAR surgery may be associated with intra- or postoperative dissection rupture or serious complications in the treatment of Grade III BTAI, the incidence rate was only 8.9%. Nevertheless, TEVAR surgery remains a safe and feasible approach for the treatment of Grade II or III BTAI, and surgical treatment should be considered first,. A high GCS score and elevated creatinine levels in the emergency department were closely associated with hospital mortality. Younger patients need long-term follow-up after TEVAR.
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影响因子：
4.3
作者：
Fortuna, Gerald R., Jr.;Perlick, Alexa;Azizzadeh, Ali
通讯作者：
Azizzadeh, Ali
影响因子：
--
作者：
Gogna, Shekhar;Gachabayov, Mahir;Latifi, Rifat
通讯作者：
Latifi, Rifat
影响因子：
2.5
作者：
Lin, Chien-Chao;Liu, Kuo-Sheng;Lin, Pyng Jing
通讯作者：
Lin, Pyng Jing
DOI：
10.1016/j.ejvs.2021.09.043
发表时间：
2022-03-15
影响因子：
5.7
作者：
Boutin, Louis;Caballero, Marie-Josee;Hamada, Sophie R.
通讯作者：
Hamada, Sophie R.
影响因子：
4.3
作者：
Madigan, Michael C.;Lewis, Anthony J.;Eslami, Mohammad H.
通讯作者：
Eslami, Mohammad H.