Læknablaðið - 15.02.1996, Blaðsíða 48

154
LÆKNABLAÐIÐ 1996; 82
Rof á brjósthluta ósæðar vegna slyss
1980-1989
Gunnar H. Gunnlaugsson, Guðni Arinbjarnar
Gunnlaugsson GH, Arinbjarnar G
Traumatic Rupture of the Thoracic Aorta in Iccland
1980-1989
Læknablaðið 1996; 82: 154-63
Introduction: Since an article was published by
Parmley in 1958 it has been generally known that
patients with traumatic rupture of the thoracic aorta
do not all die immediately. Parmley found that 20%
of the victims who did not have an associated cardiac
injury lived long enough to be brought to a hospital
making a repair of the injury at least a possibility.
During the seventies and eighties an increasing
number of case reports was pubiished where the
aortic injury had been successfully repaired and in a
few major institutions 30-40 such operations had
been performed.
Purpose: The purpose of the study was to disclose
the incidence of traumatic rupture of the thoracic
aorta in Iceland, the causes of the injury, the loca-
tion of the rupture in the vessel and to discover how
many reach to a hospital alive and are being treated.
Methods: The autopsy reports of the Section of Fo-
rensic Medicine in the Institute for Pathology at the
University of Iceland from 1980 through 1989 were
thoroughly studied. It is believed that autopsy was
performed in practically all cases of accidental death
in the study period. The injury severity score was
calculated for each individual indicating the magni-
tude of the total injury and chances of survival. The
hospital records of those admitted were studied in a
similar manner. The time from the accident to ad-
mission was noted when on record.
Results: The study revealed 57 cases of traumatic
rupture of the thoracic aorta which gives an in-
cidence of approximately 2.3 per 100,000 inhabitants
per year. Traffic accidents were the most common
cause (77%) and fall from height the second most
common. Traffic accidents happened most fre-
quently in the latter part of the week during summer
Frá '’skurðlækningadeild Borgarspítalans, 2,Rannsókna-
stofu Háskóla Islands í meinafræði, réttarlæknisfræðideild.
Fyrirspurnir, bréfaskipti: Gunnar H. Gunnlaugsson skurð-
lækningadeild Borgarspitala, 108 Reykjavík.
and fall. The use of seatbelts is unknown. The victim
was most commonly the driver or a passenger in the
front seat. Twenty nine par cent of the drivers were
drunk. Eighty four per cent of the victims were men,
most of them young. The vessel ruptured most often
at the isthmus (75%). Thirty nine of the victims
(68.4%) died at the scene of the accident and fifteen
(26.3%) were dead on arrival to the hospital in spite
of apparantly speedy ambulance services. Only
three patients reached the hospital alive (5.3%). In
most instances the aortic rupture was only a part of a
very serious multitrauma. One aortic rupture which
presented as a continuous bleeding from the left
chest was successfully repaired immediately after
arrival using simple clamp and sew technic. The
patient made a full recovery and is well 11 years after
the accident.
Conclusions: The study shows that all but three
(5.3%) of the cases with traumatic rupture of the
thoracic aorta died at the scene of the accident or
were dead upon arrival to the hospital. In most
instances the aortic rupture is only a part of a most
serious multitrauma. Patients with rupture of the
descending aorta, without major associated injuries,
who are brought quickly to the hospital can be saved
by surgically repairing the artery.
Ágrip
Inngangur: Frá 1958 þegar grein birtist eftir
Parmley hefur verið vitað að sjúklingar með
rof á brjósthluta ósæðar af völdurn slyss deyja
ekki allir strax. Parmley fann að um 20% sjúk-
linga með ósæðarrof án hjartaáverka lifðu
nægilega lengi til að komast á spítala og mögu-
leiki ætti því að vera á uppskurði. Á áttunda og
níunda áratugnum varð æ algengara að sjá í
sérfræðiritum greint frá tilfellum (case reports)
þar sem tekist hafði að gera við ósæðarrof af
þessu tagi og á nokkrum sjúkrastofnunum
höfðu verið gerðir 30^10 slíkir uppskurðir.
Tilgangur: Tilgangur rannsóknarinnar var
að finna tíðni rofs á brjósthluta ósæðar vegna
slyss hér á landi, orsakir slíkra slysa, að athuga
staðsetningu rofsins í æðinni og hversu margir
kæmust lifandi á spítala og hvernig þeim vegn-
aði.