Abstract：
BACKGROUND: Damage control surgery aims to control hemorrhage and contamination in the operating room (OR) with definitive management of injuries delayed until normal physiology is restored in the intensive care unit (ICU). There are limited studies evaluating the use of damage control thoracotomy (DCT) in trauma, and the best method of temporary closure is unclear.
METHODS: A retrospective review of trauma patients at two level I trauma centers who underwent a thoracotomy operation was performed. Subjects who underwent a thoracotomy after 24 h, age less than 16, expired in the trauma bay, or in the OR prior to ICU admission were excluded. One-way ANOVA and Kruskal-Wallis test were used to compare continuous and categorical variables between DCT and definitive thoracotomy (DT) patients.
RESULTS: 207 trauma patients underwent thoracotomy, 76 met our inclusion criteria. DCT was performed in 30 patients (39%), 46 (61 %) underwent DT operation. Techniques for temporizing the chest varied from skin closure with suture (8), adhesive dressing (5), towel clamps (2), or negative pressure devices (12). Compared to definitive closure, DCT had more derangements in HR, pH, (110 vs. 95, p = 0.04; 7.05 vs 7.24, p < 0.001), and injury severity score (41 vs 25, p < 0.001), and required more blood transfusions (40 vs 6, p < 0.001). Eleven (36.7 %) DCT patients survived to discharge compared to 38 patients (95.0 %) in the DT group. DCT showed significantly higher differences in cardiac arrest and unplanned returns to the OR rates. No differences were observed in ventilator days, or ICU length of stay.
CONCLUSIONS: DCT is a viable option for management of patients in extremis following thoracic trauma. DCT was associated with higher mortality rates, likely due to differences in injury and physiologic derangement. Despite this, DCT was associated with similar rates of complications, ICU stay, and ventilator days.
METHODS: A retrospective review of trauma patients at two level I trauma centers who underwent a thoracotomy operation was performed. Subjects who underwent a thoracotomy after 24 h, age less than 16, expired in the trauma bay, or in the OR prior to ICU admission were excluded. One-way ANOVA and Kruskal-Wallis test were used to compare continuous and categorical variables between DCT and definitive thoracotomy (DT) patients.
RESULTS: 207 trauma patients underwent thoracotomy, 76 met our inclusion criteria. DCT was performed in 30 patients (39%), 46 (61 %) underwent DT operation. Techniques for temporizing the chest varied from skin closure with suture (8), adhesive dressing (5), towel clamps (2), or negative pressure devices (12). Compared to definitive closure, DCT had more derangements in HR, pH, (110 vs. 95, p = 0.04; 7.05 vs 7.24, p < 0.001), and injury severity score (41 vs 25, p < 0.001), and required more blood transfusions (40 vs 6, p < 0.001). Eleven (36.7 %) DCT patients survived to discharge compared to 38 patients (95.0 %) in the DT group. DCT showed significantly higher differences in cardiac arrest and unplanned returns to the OR rates. No differences were observed in ventilator days, or ICU length of stay.
CONCLUSIONS: DCT is a viable option for management of patients in extremis following thoracic trauma. DCT was associated with higher mortality rates, likely due to differences in injury and physiologic derangement. Despite this, DCT was associated with similar rates of complications, ICU stay, and ventilator days.
摘要：
背景：损伤控制手术旨在控制手术室（OR）中的出血和污染，并延迟对损伤的明确处理，直到重症监护病房（ICU）恢复正常生理为止。有有限的研究评估损伤控制开胸手术（DCT）在创伤中的使用，暂时关闭的最佳方法尚不清楚。
方法：对两个一级创伤中心接受开胸手术的创伤患者进行了回顾性回顾。24小时后接受开胸手术的受试者，年龄不到16岁，在创伤湾过期，或在ICU入院前的OR中被排除.单因素方差分析和Kruskal-Wallis检验用于比较DCT和确定性开胸手术（DT）患者之间的连续和分类变量。
结果：207例创伤患者接受了开胸手术，76符合我们的纳入标准。30例患者（39%）进行了DCT，46例(61%)行DT手术。对胸部进行临时处理的技术与用缝线进行皮肤闭合不同（8），粘性敷料(5),毛巾夹（2），或负压装置(12)。与最终关闭相比，DCT在人力资源方面有更多的混乱，pH值,（110vs.95，p=0.04；7.05对7.24，p<0.001），和损伤严重程度评分（41vs25，p<0.001），并且需要更多的输血（40vs6，p<0.001）。11例（36.7％）DCT患者存活出院，而DT组为38例（95.0％）。DCT在心脏骤停和OR率的计划外恢复方面显示出显着更高的差异。呼吸机天数没有观察到差异，或ICU住院时间。
结论：DCT是治疗胸外伤后极端患者的可行选择。DCT与较高的死亡率相关，可能是由于损伤和生理紊乱的差异。尽管如此,DCT与相似的并发症发生率相关，ICU停留,和呼吸机日。
方法：对两个一级创伤中心接受开胸手术的创伤患者进行了回顾性回顾。24小时后接受开胸手术的受试者，年龄不到16岁，在创伤湾过期，或在ICU入院前的OR中被排除.单因素方差分析和Kruskal-Wallis检验用于比较DCT和确定性开胸手术（DT）患者之间的连续和分类变量。
结果：207例创伤患者接受了开胸手术，76符合我们的纳入标准。30例患者（39%）进行了DCT，46例(61%)行DT手术。对胸部进行临时处理的技术与用缝线进行皮肤闭合不同（8），粘性敷料(5),毛巾夹（2），或负压装置(12)。与最终关闭相比，DCT在人力资源方面有更多的混乱，pH值,（110vs.95，p=0.04；7.05对7.24，p<0.001），和损伤严重程度评分（41vs25，p<0.001），并且需要更多的输血（40vs6，p<0.001）。11例（36.7％）DCT患者存活出院，而DT组为38例（95.0％）。DCT在心脏骤停和OR率的计划外恢复方面显示出显着更高的差异。呼吸机天数没有观察到差异，或ICU住院时间。
结论：DCT是治疗胸外伤后极端患者的可行选择。DCT与较高的死亡率相关，可能是由于损伤和生理紊乱的差异。尽管如此,DCT与相似的并发症发生率相关，ICU停留,和呼吸机日。
