- 作者：Salomone Di Saverio ; Fausto Catena ; Filippo Filicori ; Luca Ansaloni ; Federico Coccolini ; Xavier M. Keutgen ; Aimone Giugni ; Carlo Coniglio ; Andrea Biscardi ; Piergiorgio Cavallo ; Francesca Mengoli ; Michele Masetti ; Francesco Cinquantini ; Giovanni Gordini ; Gregorio Tugnoli
- 关键词：Liver trauma ; Uncontrollable bleeding ; Perihepatic packing ; Damage control surgery ; Haemostasis ; Angioembolization ; Haemodynamic instability ; Morbidity ; Mortality ; Prognostic factors ; Trauma centre ; Trauma ICU
- 刊名：Injury
- 出版年：2012
- 出版时间：September, 2012
- 年：2012
- 卷：43
- 期：9
- 页码：1347-1354
- 全文大小：345 K
Purpose
Major liver trauma in polytraumatic patients accounts for significant morbidity and mortality. We aimed to assess prognostic factors for morbidity and mortality in patients with severe liver trauma undergoing perihepatic packing.Methods
Prospectively collected records of 293 consecutive polytrauma patients with liver injury admitted at a level I trauma centre between 1996 and 2008 were reviewed. 39 patients with grade IV-V AAST liver injury and treated with peri-hepatic packing were identified and included for analysis. Univariate and multivariate analyses were performed to assess prognostic factors for morbidity and mortality.
Results
Mean age of patients was 41 years. 34 patients were haemodynamically unstable at initial presentation. Ten of 39 patients were treated with angiographic embolization in addition to perihepatic packing. The overall mortality rate was 51.3 % . Liver-related death occurred in 23.1 % . Overall and liver-related morbidity rates were 90 % and 28 % , respectively. Glasgow Coma Scale (GCS), respiratory rate, packed red blood cells (PRBC) transfusion, pH and Base Excess (BE), Revised Trauma Score (RTS) and Trauma Injury Severity Score (TRISS), need for angiographic embolization as well as early OR and ICU admission were associated with significant decrease of early mortality.
Conclusions
Revised Trauma Score, haemodynamic instability, blood pH and BE are important prognostic factors influencing morbidity and mortality in polytrauma patients with grade IV/V liver injury. Furthermore, fast and effective surgical damage control procedure with perihepatic packing, followed by early ICU admission is associated with lower complication rate and shorter ICU stays in this patient population.