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

doi:10.3877/cma.j.issn.1674-6902.2024.05.016

Abstract

Abstract:

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） 7 379.00（2 300.78，9 758.00）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 2 501.50 （1 099.44， 6 404.50）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 significantly improves the prognosis for those receiving non-surgical interventions.

Key words: Blunt thoracic trauma, Clinical characteristics, Elderly, Critical care

Shifeng Shao, Qin Xiao, Fanglong Shen, Xun Zhang, Zhipeng Hao, Zhengbin Wu, Xiaojuan Xie, Yaoli Wang. Analysis of severe rescue treatment for blunt trauma aortic arch in the elderly[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(05): 762-767.

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Figures/Tables 3

References 30

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临床资料	观察组（n=9）	对照组（n=10）	t/U值	P值
心率（次/min）	80.78±17.31	95.00±15.43	1.894	0.075
舒张压（mmHg）	56.44±16.49	59.70±17.79	0.412	0.685
WBC（10⁹/L）	11.5±4.55	13.51±7.17	0.720	0.482
PLT（10⁹/L）	175.56±59.49	217.6±201.79	0.600	0.556
Fib（g/L）	3.11（2.69，4.73）	3.28（2.66，4.18）	34	0.633
D-D（μg/L）	7 379.00（2 300.78，9 758.00）	2 501.50（1 099.44，6 404.50）	28	0.481
cTnT（μg/L）	0.01（0.01，0.02）	0.11（0.01，0.27）	19	0.699
住院时间（d）	14（7，18）	21（17，32）	18	0.026
ICU时间（d）	0（0，5）	8（4，12）	16	0.015
住院次数	0（0，1）	1（1，2）	14	0.004

临床资料	观察组（n=9）	对照组（n=10）	t/U值	P值
心率（次/min）	80.78±17.31	95.00±15.43	1.894	0.075
舒张压（mmHg）	56.44±16.49	59.70±17.79	0.412	0.685
WBC（10⁹/L）	11.5±4.55	13.51±7.17	0.720	0.482
PLT（10⁹/L）	175.56±59.49	217.6±201.79	0.600	0.556
Fib（g/L）	3.11（2.69，4.73）	3.28（2.66，4.18）	34	0.633
D-D（μg/L）	7 379.00（2 300.78，9 758.00）	2 501.50（1 099.44，6 404.50）	28	0.481
cTnT（μg/L）	0.01（0.01，0.02）	0.11（0.01，0.27）	19	0.699
住院时间（d）	14（7，18）	21（17，32）	18	0.026
ICU时间（d）	0（0，5）	8（4，12）	16	0.015
住院次数	0（0，1）	1（1，2）	14	0.004

损伤机制		观察组	对照组	χ²值	P值
损伤类型				0.781	0.809
	Stanford A	4	3
	Stanford B	4	6
夹层起始部位				6.455	0.118
	主动脉瘤样扩张	1	1
	主动脉根部	1	1
	升主动脉	2	0
	主动脉弓	0	3
	降主动脉	4	6
	腹主动脉	2	0

损伤机制		观察组	对照组	χ²值	P值
损伤类型				0.781	0.809
	Stanford A	4	3
	Stanford B	4	6
夹层起始部位				6.455	0.118
	主动脉瘤样扩张	1	1
	主动脉根部	1	1
	升主动脉	2	0
	主动脉弓	0	3
	降主动脉	4	6
	腹主动脉	2	0

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