Blunt Aortic Injury wit Concomitant Intraabdominal Solid 主动脉钝器损伤并发腹腔内固体.pptVIP

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2018-06-19 发布于福建
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Blunt Aortic Injury wit Concomitant Intraabdominal Solid 主动脉钝器损伤并发腹腔内固体.ppt

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Blunt Aortic Injury wit Concomitant Intraabdominal Solid 主动脉钝器损伤并发腹腔内固体

Blunt Aortic Injury with Concomitant Intra-abdominal Solid Organ Injury: Treatment Priorities Revisited Santaniello J, et al, The Journal of TRAUMA Injury, Infection, and Critical Care. 2002;53:442–445. Background Blunt aortic injury (BAI): 90% mortality within first 24 hours Second leading cause of death in blunt trauma 15%~20% BAI patient with concomitant liver/spleen (L/S) injuries Cardiopulmonary bypass with heparinization for repair of BAI ? L/S operation before aortic repair? Majority of blunt L/S injuries are now treated non-operatively in hemodynamically stable patients Evaluates safety of acute BAI repair using partial bypass with full heparinization in patients undergoing non-operative management (NOM) for low-grade blunt L/S injuries Patients and Methods BAI patient in Presley Regional Trauma Center over a 6-year period Study group: Patient with concomitant liver or spleen injury (Aorta L/S group) Control: patient with L/S injury but without BAI (L/S group) Aortic Injury Management Patient screened by chest abdominal CT ? thoracic aortography Blood pressure and heart rate controlled pharmacologically to (SBP~100mmHg, HR 100 bpm) BAI repaired by partial bypass with full heparinization Solid Organ Injury Management Diagnosed by CT and graded by American Assoiciation for the Surgery of Trauma organ injury scale Aorta L/S vs. L/S Aorta L/S vs. Aorta Results 84 patients with BAI 56 p’t without associated intra-abdominal injury 28 p’t with concomitant liver and/or spleen injury Aorta L/S group: 20 patients with solid organ injury (Table 1) L/S group: 894 patients with grade I/II hepatic or splenic injury Aorta L/S group vs. L/S group (Table 2) Aorta L/S group vs. Aorta group (Table 3) Complication rates (Table 4) Results No difference in resource use (length of stay) or failure of non-operative solid organ injury management Similar overall complication rate Discussion1 Past: positive peritoneal lavage ? laparotomy ? aortic repair Present: recent s