老年胸主动脉钝性伤的重症救治分析  

Analysis of severe rescue treatment for blunt trauma aortic arch in the elderly

作　　者：邵世锋 肖钦 沈方龙 张迅 郝志鹏 伍正彬 谢晓娟 王耀丽[1] Shao Shifeng;Xiao Qin;Shen Fanglong;Zhang Xun;Hao Zhipeng;Wu Zhengbin;Xie Xiaojuan;Wang Yaoli(Department of Critical Care Medicine,Daping Hospital,Army Military Medical University,Chongqing 400042,China;Department of Radiology,Daping Hospital,Army Military Medical University,Chongqing 400042,China;Department of Thoracic Surgery,Daping Hospital,Army Military Medical University,Chongqing 400042,China;Department of Critical Care Medicine,Yongchuan District People′s Hospital,Chongqing 402160,China)

机构地区：[1]陆军(第三)军医大学大坪医院重症医学科,重庆400042 [2]陆军(第三)军医大学大坪医院放射科,重庆400042 [3]陆军(第三)军医大学大坪医院胸外科,重庆400042 [4]重庆市永川区人民医院重症医学科,重庆402160

出　　处：《中华肺部疾病杂志（电子版）》2024年第5期762-767,共6页Chinese Journal of Lung Diseases(Electronic Edition)

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：目的分析老年胸主动脉钝性伤(blunt traumatic aortic injury,BTAI)的临床特点及损伤机制,对老年BTAI重症救治经验进行分析。方法选择2013年1月至2022年1月我院重症医学科(intensive care unit,ICU)收治的BTAI患者19例,≥60岁9例为观察组,<60岁10例为对照组,比较两组疾病发生、发展及转归差异,总结重症救治策略。结果观察组Stanford分型、损伤起始部位、治疗前心率(80.78±17.31)次/min、脉压差(56.44±16.49)mmHg、白细胞(white blood cell,WBC)(11.50±4.55)109/L、血小板(platelet counts,PLT)(175.56±59.49)109/L、纤维蛋白原(fibrinogen,Fib)3.11(2.69,4.73)g/L、血清D-二聚体(D-dimer,D-D)7379.00(2300.78,9758.00)μg/L、肌钙蛋白T(cardiac troponin,cTnT)0.01(0.01,0.02)μg/L较对照组Stanford分型、损伤起始部位、治疗前心率(95.00±15.43)次/min、脉压差(59.70±17.79)mmHg、WBC(13.51±7.17)109/L、PLT(217.60±201.79)109/L、Fib 3.28(2.66,4.18)g/L、DD 2501.50(1099.44,6404.50)μg/L、cTnT 0.11(0.01,0.27)μg/L差异无统计学意义(P>0.05)。观察组手术治疗3例(33.33%)低于对照组手术治疗9例(90.00%)(P<0.05);观察组住院时间14(7,18)d、ICU住院时间0(0,5)d、再次入住ICU次数0(0,1)次与对照组住院时间21(17,32)d、ICU住院时间8(4,12)d、再次入住ICU次数1(1,2)次比较差异有统计学意义(P<0.05)。结论BTAI全年龄段可发生,老年BTAI Stanford分型、损伤特点及临床表现与年轻BTAI无差异;老年BTAI治疗选择非手术治疗为主,ICU重症综合救治管理改善老年BTAI非手术治疗预后。Objective To analyze the clinical characteristics and injury mechanism of blunt traumatic aortic injury(BTAI)in the elderly,and to discuss the experience of severe treatment of BTAI in the elderly.Methods A total of 19 BTAI patients admitted to the intensive care unit(ICU)of our hospital from January 2013 to January 2022 were selected,with 9 patients≥60 years old as the observation group and 10 patients<60 years old as the control group.The differences in disease occurrence,development and outcome between the two groups were compared,and the critical treatment strategies were summarized.Results Stanford classification,injury start site,heart rate before treatment(80.78±17.31)times/min,pulse pressure difference(56.44±16.49)mmHg,white blood cell(WBC)(11.50±4.55)109/L,platelet counts(PLT)(175.56±59.49)109/L,fibrinogen(Fib)3.11(2.69,4.73)g/L,serum D-dimer(D-D)7379.00(2300.78,9758.00)μg/L,cardiac troponin T(cardiac troponin,cTnT)0.01(0.01,0.02)μg/L in observation group compared with Stanford classification,injury initiation site,heart rate before treatment(95.00±15.43)times/min,pulse pressure difference(59.70±17.79)mmHg,WBC(13.51±7.17)109/L,PLT(217.60±201.79)109/L Fib 3.28(2.66,4.18)g/L,D-D 2501.50(1099.44,6404.50)μg/L,cTnT 0.11(0.01,0.27)μg/L in control group(P>0.05).There were 3 cases(33.33%)in the observation group and 9 cases(90.00%)in the control group(P<0.05).The length of stay in the observation group was 14(7,18)d,the length of stay in the ICU was 0(0,5)d and the number of re-admission to the ICU was 0(0,1)times compared with the length of stay in the ICU was 21(17,32)d,the length of stay in the ICU was 8(4,12)d and the number of readmission to the ICU was 1(1,2)times(P<0.05)in the control group.Conclusion BTAI can occur across all age groups.The Stanford classification,injury characteristics,and clinical features of elderly BTAI patients show no differences compared to younger counterparts.For elderly BTAI patients,non-surgical treatment is primarily chosen,and intensive care unit management sig

关 键 词：主动脉钝性伤 临床特点 老年人 重症监护 

分 类 号：R563[医药卫生—呼吸系统]