《美国创伤外科协会-世界急诊外科学会颈部血管损伤诊断与处理指南》解读

Interpretation of the American Association for the Surgery of Trauma-World Society of Emergency Surgery guidelines for the diagnosis and management of cervical vascular injuries

摘要:

颈部血管损伤（CVI）是创伤外科救治中最具挑战性的急危重症之一，包括钝性脑血管损伤（BCVI）和穿透性CVI，两者在筛查、诊断及治疗策略方面存在明显差异。2026年，美国创伤外科协会联合世界急诊外科学会首次发布《颈部血管损伤诊断与处理指南》，系统整合了近年来循证医学证据，对CVI的筛查、影像学诊断、抗血栓治疗、血管腔内介入及穿透性损伤处理策略进行了全面更新。该指南提出，BCVI应由传统的症状驱动诊疗转向高危人群主动筛查，强调抗血栓治疗是绝大多数BCVI患者的基础治疗，仅在特定情况下实施血管腔内介入；对于穿透性颈部损伤，则推荐依据血流动力学状态及临床体征实施“无分区”管理策略，以替代传统的解剖分区处理模式。本文结合指南推荐意见及主要循证依据，对其关键更新内容进行系统解读，并结合我国脑血管疾病负担及临床实践特点，对指南在国内的适用性及未来研究方向进行分析，以期为我国CVI的规范化诊疗提供参考。

Abstract:

Cervical vascular injuries (CVIs), including blunt cerebrovascular injury (BCVI) and penetrating cervical vascular injury, are among the most challenging emergencies encountered in trauma surgery because of their distinct diagnostic and therapeutic characteristics. In 2026, the American Association for the Surgery of Trauma and the World Society of Emergency Surgery jointly published the first evidence-based guidelines for the diagnosis and management of CVIs. The guidelines comprehensively update current recommendations on screening, imaging evaluation, antithrombotic therapy, endovascular intervention, and management of penetrating cervical vascular injuries. Major advances include shifting the management of BCVI from symptom-driven diagnosis to proactive screening of high-risk patients, establishing antithrombotic therapy as the cornerstone of treatment while restricting endovascular intervention to selected indications, and replacing the traditional anatomical zone-based approach for penetrating injuries with a hemodynamic- and clinical sign-based "no-zone" strategy. This review systematically interprets the key recommendations and supporting evidence of the guidelines and discusses their applicability in the Chinese clinical setting in light of the high burden of cerebrovascular disease in China. It is expected to provide a useful reference for the standardized diagnosis and management of cervical vascular injuries in clinical practice.