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Second hit phenomenon: existing evidence of clinical implications.

机译：重击现象：现有的临床意义证据。

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The last two decades extensive research evidence has been accumulated regarding the pathophysiology of trauma and the sequelae of interventions that follow. Aim of this analysis has been to collect and categorise the existing data on the so-called "second hit" phenomenon that includes the biochemical and physiologic alterations occurring in patients having surgery after major trauma. Articles were extracted from the PubMed database and the retrieved reports were included in the study only if pre-specified eligibility criteria were fulfilled. Moreover, a constructed questionnaire was utilised for quality assessment of the outcomes. Twenty-six articles were eligible for the final analysis, referring to a total of 8262 patients that underwent surgery after major trauma. Sixteen retrospective clinical studies including 7322 patients and 10 prospective ones, including 940 patients were evaluated. Several variables able to reproduce a post-operative second hit were identified; mostly related to pulmonary dysfunction, coagulopathy, fat or pulmonary embolism, and the inflammatory immune system. Indicative conclusions were extracted, as well as the need for further prospective randomised trials. Suggestions on the content and the rationale of future studies are provided.
机译：在过去的二十年中，有关创伤的病理生理学和随后的干预措施的后遗症已经积累了广泛的研究证据。该分析的目的是收集和分类有关所谓的“第二击”现象的现有数据，该数据包括发生重大创伤后进行手术的患者发生的生化和生理变化。仅当符合预先指定的资格标准时，才从PubMed数据库中提取文章，并将检索到的报告包括在研究中。此外，使用构建的调查表对结果进行质量评估。有26篇文章符合最终分析的条件，涉及总共8262例在重大创伤后接受手术的患者。评价了16项回顾性临床研究，包括7322例患者和10项前瞻性研究，其中940例患者。确定了几个能够重现术后第二次发作的变量。主要与肺功能障碍，凝血病，脂肪或肺栓塞以及炎性免疫系统有关。得出了结论性结论，以及对进一步前瞻性随机试验的需求。提供了有关未来研究的内容和理由的建议。

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