Predictive factors of mortality in patients with pelvic fracture and shock submitted to extraperitoneal pelvic packing

ABSTRACT Introduction: in recent decades, the extraperitoneal pelvic packing technique has been disseminated, but there are still few studies. Thus, it was decided to analyze the results of extraperitoneal pelvic tamponade, in patients with pelvic fracture and shock, in order to identify predictive factors for mortality. Methods: a retrospective review of medical records of patients submitted to extraperitoneal pelvic packing was conduced. We analyzed their characteristics, prehospital and emergency room data, pelvic fracture classification, associated and severity injuries, laboratory and imaging exams, data on packing, arteriography, and other procedures performed, complications, hemodynamic parameters, and amount of transfused blood products before and after packing. Results: data were analyzed from 51 patients, who showed signs of shock from prehospital care, presence of acidosis, with high base deficit and arterial lactate levels. Most patients underwent multiple surgical procedures due to severe associated injuries. The incidence of coagulopathy was 70.58%, and overall mortality was 56.86%. The group of non-surviving patients presented significantly higher age, prehospital endotracheal intubation, and lower Glasgow Coma Scale scores (p【摘要】 引言：近数十年来，腹膜外骨盆填塞术（extraperitoneal pelvic packing）已得到广泛推广，但相关研究仍较为稀缺。为此，本研究针对骨盆骨折合并休克患者的腹膜外骨盆填塞治疗效果展开分析，旨在明确患者死亡的预测因素。 方法：本研究对接受腹膜外骨盆填塞术的患者的病历资料开展回顾性分析。我们对患者的基线特征、院前及急诊室诊疗数据、骨盆骨折分型、合并损伤与损伤严重程度、实验室与影像学检查结果、骨盆填塞术相关数据、动脉造影及其他实施的手术操作情况、并发症、血流动力学参数，以及骨盆填塞术前后输注的血液制品剂量进行了分析。 结果：本研究共纳入51例患者，这些患者在院前急救阶段即出现休克征象，且存在酸中毒，表现为碱剩余显著降低及动脉血乳酸水平升高。多数患者因合并严重损伤而接受了多台外科手术。凝血功能障碍的发生率为70.58%，总体死亡率为56.86%。非存活组患者的年龄显著更高，院前气管插管比例更高，格拉斯哥昏迷量表（Glasgow Coma Scale）评分更低（p