Blunt aortic injury: risk factors and impact of surgical approaches
Blunt aortic injury: risk factors and impact of surgical approaches
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DOI：
10.1007/s00595-015-1152-0
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发表时间：
2016-02-01
期刊：
影响因子：
2.5
通讯作者：
Lin, Pyng Jing
中科院分区：
文献类型：
--
作者：
Lin, Chien-Chao;Liu, Kuo-Sheng;Lin, Pyng Jing
目的总结17年来闭合性创伤性主动脉损伤(BTAI)的治疗经验。结果1995年10月至2012年6月，88例BTAI患者入选本研究，男74例，女14例，年龄15~79岁，平均39.9±17.9岁。GCS为12.9+/-3.7，ISS为29.2+/-9.8，RTS为6.9+/-1.4。非手术治疗21例(23.8%)，开放手术修复49例(55.7%)，血管内修复18例(20.5%)。住院病死率17.1%(15/81)，血管内修复组无死亡。平均随访39.9+/-44.2个月。与死亡患者相比，闭合性主动脉损伤幸存者的ISS、RTS、TRISS和血肌酐水平较低，大量输血、休克和插管率较低，尽管血管内修复、血红蛋白和GCS的发生率较高。主动脉损伤的程度、不同的治疗方案、GCS评分、休克表现和到达时插管均对预后有显著影响。结论休克、主动脉损伤严重程度、合并创伤严重程度和不同的手术方式影响生存率。血管内修复术取得了较好的中期效果，是治疗BTAI的合理选择。
Purpose This study reviews our 17-year experience of managing blunt traumatic aortic injury (BTAI). Methods We analyzed information collected retrospectively from a tertiary trauma center.Results Between October 1995 and June 2012, 88 patients (74 male and 14 female) with a mean age of 39.9 +/- 17.9 years (range 15-79 years) with proven BTAI were enrolled in this study. Their GCS, ISS, and RTS scores were 12.9 +/- 3.7, 29.2 +/- 9.8, and 6.9 +/- 1.4, respectively. Twenty-one (23.8 %) patients were managed non-operatively, 49 (55.7 %) with open surgical repair, and 18 (20.5 %) with endovascular repair. The in-hospital mortality rate was 17.1 % (15/81) and there were no deaths in the endovascular repair group. The mean follow-up period was 39.9 +/- 44.2 months. The survivors of blunt aortic injury had lower ISS, RTS, TRISS, and serum creatinine level and lower rate of massive blood transfusion, shock, and intubation than the patients who died, despite higher rates of endovascular repair, hemoglobin, and GCS on presentation. The degree of aortic injury, different therapeutic options, GCS, shock presentation, and intubation on arrival all had significant impacts on outcome.Conclusions Shock, aortic injury severity, coexisting trauma severity, and different surgical approaches impact survival. Endovascular repair achieves a superior mid-term result and is a reasonable option for treating BTAI.