CAJ | 학술논문

目的探讨超声造影对腹部实质脏器创伤程度进行快速评估的价值及与临床治疗方案相关的因素分析.方法应用超声造影观察52例腹部实质脏器创伤患者,根据美国创伤外科协会(AAST)标准判断创伤程度,观察腹腔积液变化、活动性出血、累及血管级别等情况,建立快速评估创伤严重程度的方法,并研究不同程度创伤与手术和保守治疗的相关性.结果 52例患者共71个不同程度的实质脏器破裂,复合伤占82.7％(43/52).其中37个Ⅰ～Ⅲ级较低级别创伤,34个Ⅳ～Ⅴ级严重创伤.超声造影观察伴活动性出血的病灶占76.1％(54/71),其中伴快速出血的7个创伤灶,腹腔积液在30 min内明显增加(P＜0.05).伴活动性出血的50个创伤灶中,手术治疗的比例为24.0％(12/50),保守治疗的比例为76.0％(38/50).创伤累及二级以下血管的病灶,Ⅰ～Ⅲ级创伤占97.3％(36/37),Ⅳ～Ⅴ级创伤占61.8％(21/34);创伤灶累及二级以上血管的病灶,手术治疗占23.1％(12/52),保守治疗占44.2％(23/52).结论根据病灶范围判断创伤程度的AAST标准不能全面反映创伤的严重程度,它不仅与创伤灶的范围有关,还与创伤累及的血管级别、是否伴发活动性出血、出血的速度,以及腹腔积液量等因素有关.
목적 탐토초성조영대복부실질장기창상정도진행쾌속평고적개치급여림상치료방안상관적인소분석.방법 응용초성조영관찰52례복부실질장기창상환자,근거미국창상외과협회(AAST)표준판단창상정도,관찰복강적액변화、활동성출혈、루급혈관급별등정황,건립쾌속평고창상엄중정도적방법,병연구불동정도창상여수술화보수치료적상관성.결과 52례환자공71개불동정도적실질장기파렬,복합상점82.7％(43/52).기중37개Ⅰ～Ⅲ급교저급별창상,34개Ⅳ～Ⅴ급엄중창상.초성조영관찰반활동성출혈적병조점76.1％(54/71),기중반쾌속출혈적7개창상조,복강적액재30 min내명현증가(P＜0.05).반활동성출혈적50개창상조중,수술치료적비례위24.0％(12/50),보수치료적비례위76.0％(38/50).창상루급이급이하혈관적병조,Ⅰ～Ⅲ급창상점97.3％(36/37),Ⅳ～Ⅴ급창상점61.8％(21/34);창상조루급이급이상혈관적병조,수술치료점23.1％(12/52),보수치료점44.2％(23/52).결론 근거병조범위판단창상정도적AAST표준불능전면반영창상적엄중정도,타불부여창상조적범위유관,환여창상루급적혈관급별、시부반발활동성출혈、출혈적속도,이급복강적액량등인소유관.
Objective To quickly evaluate the traumatic degree of abdominal solid-organs using contrast-enhanced ultrasonography (CEUS) and analysis on related factors with clinical treatment.Methods 52 patients with abdominal traumatic were observed by CEUS,and the traumatic degree was judged according to American Association for the Surgery of Trauma (AAST).The change of peritoneal fluid was observed with ultrasonography,and active bleeding and involve adjacent vessels their branches were observed with CEUS.In this way,a method of quickly evaluate the traumatic degree was established,and the correlation between indifferent grade trauma and appropriate interventions that include surgical and conservative treatment was studied.Results 52 patients with 71 lesions,compound injuries accounted for 82.7％ (43/52).Among them,37 lesions were Ⅰ-Ⅲ grade trauma,34 lesions were severe trauma of Ⅳ-Ⅴ grade.The lesions complicated with active bleeding were 76.1％ (54/71).The amount of peritoneal fluid was increased significantly within 30 min (P ＜0.05) in traumatic lesions with rapid bleeding.Among of 50lesions associated with active bleeding,the surgical treatment was 24.0％ (12/50),the conservative treatment was 76.0％ (38/50).Among of trauma lesions involving the two following vessels,Ⅰ-Ⅲ grade was 97.3％ (36/37),Ⅳ-Ⅴ grade was 61.8％ (21/34).Trauma involvement above level 2 focal blood vessels,surgical treatment accounted for 23.1％ (12/52),conservative treatment accounted for 44.2％(23/52).Conclusions The severity of the trauma can not be a comprehensive response by AAST,becauce it is not only related to the scope of the traumatic lesions,vascular level,also involved with the trauma associated with active bleeding,bleeding speed and amount of peritoneal effusion and other factors.