主动脉钝性伤的单中心重症救治经验  

A single-center intensive care experience on the management of blunt traumatic aortic injury

作　　者：邵世锋 肖钦 伍正彬 王耀丽 Shao Shifeng;Xiao Qin;Wu Zhengbin;Wang Yaoli(Department of Intensive Care Unit,Daping Hospital,Army Medical University,Chongqing 400042,China)

机构地区：[1]陆军军医大学大坪医院重症医学科,重庆400042

出　　处：《创伤与急诊电子杂志》2024年第1期1-7,共7页Journal of Trauma and Emergency(Electronic Version)

基　　金：全军临床重点专科;重庆市技术创新与应用发展专项重点项目(CSTC2021jscx-gksb-N0007)

摘　　要：目的总结分析主动脉钝性伤(blunt traumatic aortic injury,BTAI)的临床特点和重症管理经验。方法回顾性分析2013年1月至2022年1月陆军军医大学大坪医院重症医学科收治的BTAI 14例患者的临床资料,采用描述性研究方法,分析近9年陆军军医大学大坪医院ICU收治的BTAI患者病例特征及重症管理经验。结果14例患者中主要为高处坠落伤(35.71%)和道路交通伤(35.71%)致主动脉损伤,其中1例为爆炸伤所致。14例患者均为入院后行影像学检查发现,主动脉损伤中有内膜撕裂夹层形成11例(StanfordA型4例,Stanford B型7例),假性动脉瘤样改变3例。其中1例患者胸主动脉至腹主动脉全程撕裂,1例胸主动脉至右侧髂外动脉全程撕裂。手术治疗11例(78.57%),无手术指征行保守治疗3例(21.43%)。平均住院天数20.5(14,27.5)d,其中ICU住院时间6(4.25,11)d,最短住ICU天数2d,最长住ICU时间为71d。救治好转出院13例(92.86%)。结论BTAI伤后伤情隐匿,多发生于高处坠落或道路交通伤后,爆炸所致冲击波也可导致。早期明确诊断多依赖于影像学检查,重症监护管理可能是BTAI较好预后及减少并发症的重要手段。Objective To summarize and analyze the clinical characteristics and critical care management experience of BTAI(blunt traumatic aortic injury).Method In a retrospective analysis of the clinical data of 14 patients with BTAI admitted to the Intensive Care Unit of the Daping Hospital of Army Medical University from January 2013 to January 2022,descriptive research methods were used to analyze the case characteristics and intensive care management experience.Result The 14 cases of BTAI were mainly attributed to falls from heights(35.71%)and traffic accidents(35.71%),including 1 case resulting from blast injuries.All cases were diagnosed through imaging studies after admission,with 11 cases showing intimal tears and intramural hematomas in aortic injuries(4 Stanford A type and 7 Stanford B type),and 3 cases showing pseudoaneurysm-like changes.Among them,1 case had a full-length tear from the thoracic aorta to the abdominal aorta,and 1 case had a tear from the thoracic aorta to the right external iliac artery.Surgical treatment was performed in 11 cases(78.57%),while 3 cases(21.43%)underwent conservative treatment due to lack of surgical indications.The average length of hospitalization was 20.5(14,27.5)days,with a mean intensive care unit(ICU)stay of 6(4.25,11)days.The shortest ICU stay was 2 days,and the longest ICU stay was 71 days.Thirteen cases(92.86%)were discharged from the hospital.Conclusion BTAI is often missed and commonly occurs after falls from a height or as a result of traffic accidents.It can also be caused by the shockwaves of explosions.Early definitive diagnosis largely relies on imaging examinations.Intensive care management may be crucial for better prognosis and prevention of complications in BATI.

关 键 词：钝性主动脉损伤 创伤 临床特点 重症监护 治疗 

分 类 号：R654.3[医药卫生—外科学]