Clinical outcomes of sandwich negative pressure gauze packing in treatment of severe abdominal trauma with hemorrhage

doi:10.3877/cma.j.issn.1674-6880.2021.06.003

Abstract

Abstract:

Objective

To explore the effect of "sandwich" method of negative pressure gauze packing in the treatment of severe abdominal trauma with bleeding.

Methods

A retrospective case-control study was used to analyze the clinical data of 40 patients with severe abdominal trauma combined with bleeding who were treated with gauze packing due to ineffective hemostasis by drugs, intervention and surgery in the Division of Trauma and Surgical Intensive Care Unit, General Hospital of Eastern Theater Command from January 2016 to September 2020. According to the gauze packing method, they were divided into a traditional gauze packing group (traditional group, 19 cases) and a "sandwich" negative pressure gauze packing group ("sandwich" group, 21 cases). The general data, injury severity score (ISS), sequential organ failure assessment (SOFA) score, intraoperative conditions and ICU resuscitation data, vital signs and laboratory tests, complications, prognosis and follow-up data were compared between the two groups.

Results

The vital signs of the two groups were improved after surgical gauze packing for hemostasis and ICU resuscitation support. In the "sandwich" group, the ISS scores [(26 ± 4) vs. (19 ± 6)], SOFA scores [(16 ± 3) vs. (13 ± 4)] and gauze packing time [(5.0 ± 1.2) d vs. (3.0 ± 0.7) d] were significantly higher than those in the traditional group (t = 4.494, 2.713, 6.404; all P < 0.05). The body temperature, heart rate, pH, hemoglobin, white blood cell count, procalcitonin, C-reactive protein, D-dimer, prothrombin time and activated partial prothrombin time levels during damage control surgery, on the 3rd day after surgery and during definitive surgery were statistically significantly different between the two groups (F = 27.590, 25.533, 39.777, 17.483, 4.486, 44.236, 5.628, 38.616, 8.689, 13.212; all P < 0.05). The postoperative infection (3 / 21 vs. 8 / 19) and overall complications (5 / 21 vs. 13 / 19) in the "sandwich" group were significantly lower than those in the traditional group ( χ² = 3.872, 8.021; P = 0.049, 0.005); however, there was no significant difference in death between the two groups (1 / 21 vs. 3 / 19, χ² = 1.348, P = 0.331). The discharged patients were followed up for (6 ± 3) months and all survived.

Conclusions

For patients with severe abdominal trauma and bleeding, gauze packing can improve their vital signs. Compared with traditional gauze packing, the "sandwich" method of negative pressure gauze packing can significantly extend the packing time, reduce systemic infections and decrease the incidence of complications.

Key words: Wounds and injuries, Hemorrhage, Hemostatic techniques, Gauze packing

Chengnan Chu, Weiwei Ding, Chao Yang, Xinyu Wang, Fang Chen, Kai Wang, Weiqin Li, Jieshou Li. Clinical outcomes of sandwich negative pressure gauze packing in treatment of severe abdominal trauma with hemorrhage[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2021, 14(06): 453-459.

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Figures/Tables 4

References 20

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组别	例数	年龄（岁）	性别（例，男/女）	致伤原因（例）			ISS评分（分）
组别	例数	年龄（岁）	性别（例，男/女）	车祸伤	高处坠落伤	重物挤压伤	ISS评分（分）
传统组	19	41 ± 13	17 / 2	16	2	1	19 ± 6
"三明治"组	21	44 ± 12	18 / 3	17	3	1	26 ± 4
t / χ²值		0.930	0.129	0.073	0.129	0.005	4.494
P值		0.358	0.720	0.787	0.720	0.942	< 0.001
组别	例数	损伤部位（例）					SOFA评分（分）
组别	例数	肝脏外伤	胰腺外伤	盆会阴损伤	下腔静脉破裂	其他	SOFA评分（分）
传统组	19	8	7	1	1	2	13 ± 4
"三明治"组	21	9	8	1	1	2	16 ± 3
t / χ²值		0.002	0.007	0.005	0.005	0.011	2.713
P值		0.962	0.935	0.942	0.942	0.916	0.011

组别	例数	年龄（岁）	性别（例，男/女）	致伤原因（例）			ISS评分（分）
组别	例数	年龄（岁）	性别（例，男/女）	车祸伤	高处坠落伤	重物挤压伤	ISS评分（分）
传统组	19	41 ± 13	17 / 2	16	2	1	19 ± 6
"三明治"组	21	44 ± 12	18 / 3	17	3	1	26 ± 4
t / χ²值		0.930	0.129	0.073	0.129	0.005	4.494
P值		0.358	0.720	0.787	0.720	0.942	< 0.001
组别	例数	损伤部位（例）					SOFA评分（分）
组别	例数	肝脏外伤	胰腺外伤	盆会阴损伤	下腔静脉破裂	其他	SOFA评分（分）
传统组	19	8	7	1	1	2	13 ± 4
"三明治"组	21	9	8	1	1	2	16 ± 3
t / χ²值		0.002	0.007	0.005	0.005	0.011	2.713
P值		0.962	0.935	0.942	0.942	0.916	0.011

组别	例数	术中出血量（mL）	ICU复苏时间（d）	ICU住院时间（d）	填塞时间（d）
传统组	19	1 474 ± 762	2.0 ± 0.8	30 ± 18	3.0 ± 0.7
"三明治"组	21	1 481 ± 803	2.1 ± 0.7	28 ± 17	5.0 ± 1.2
t值		0.029	0.203	0.355	6.404
P值		0.977	0.841	0.724	< 0.001

组别	例数	术中出血量（mL）	ICU复苏时间（d）	ICU住院时间（d）	填塞时间（d）
传统组	19	1 474 ± 762	2.0 ± 0.8	30 ± 18	3.0 ± 0.7
"三明治"组	21	1 481 ± 803	2.1 ± 0.7	28 ± 17	5.0 ± 1.2
t值		0.029	0.203	0.355	6.404
P值		0.977	0.841	0.724	< 0.001

组别	时间	例数	体温（℃）	心率（次/ min）	pH值	血红蛋白（g / L）	白细胞计数（× 10⁹ / L）
传统组	损伤控制性手术时	19	36.3 ± 0.7	122 ± 20	7.334 ± 0.021	68 ± 13	9 ± 4
	损伤控制性手术后第3天	19	37.7 ± 0.4^a	98 ± 11^a	7.389 ± 0.018^a	94 ± 18^a	10 ± 3
	确定性手术时	19	38.3 ± 0.6^ab	102 ± 9^a	7.407 ± 0.026^a	95 ± 8^a	12 ± 3
"三明治"组	损伤控制性手术时	21	36.3 ± 0.6	122 ± 18	7.323 ± 0.022	74 ± 11	15 ± 5
	损伤控制性手术后第3天	21	37.5 ± 0.7^a	91 ± 5^a	7.385 ± 0.017^a	91 ± 15^a	13 ± 7
	确定性手术时	21	37.3 ± 0.9^ac	90 ± 8^ac	7.379 ± 0.033^ac	90 ± 6^a	10 ± 4^a
F值			27.590	25.533	39.777	17.483	4.486
P值			0.001	0.001	0.001	0.001	< 0.001
组别	时间	例数	血小板计数（× 10⁹ / L）	降钙素原（μg / L）	C反应蛋白（mg / L）	D-二聚体（mg / L）	PT（s）	APTT（s）
传统组	损伤控制性手术时	19	127 ± 55	7 ± 3	115 ± 54	15.5 ± 5.1	17.5 ± 2.7	65 ± 18
	损伤控制性手术后第3天	19	176 ± 104	20 ± 7^a	160 ± 15^a	8.3 ± 3.9^a	14.2 ± 1.7^a	42 ± 11^a
	确定性手术时	19	159 ± 115	25 ± 4^ab	154 ± 59	5.6 ± 1.9^a	14.6 ± 1.9^a	49 ± 20^a
"三明治"组	损伤控制性手术时	21	125 ± 64	17 ± 8	85 ± 49	6.1 ± 3.3	16.8 ± 2.1	80 ± 33
	损伤控制性手术后第3天	21	113 ± 82	11 ± 5^ac	151 ± 83^a	3.1 ± 1.8^a	14.4 ± 1.5^a	52 ± 14^a
	确定性手术时	21	133 ± 75	6 ± 2^abc	108 ± 63	4.1 ± 1.8^a	14.8 ± 2.5^a	39 ± 7^a
F值			1.534	44.236	5.628	38.616	8.689	13.212
P值			0.185	0.001	0.001	0.001	0.001	0.001

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