CAJ | 학술논문

目的：总结和分析血流动力学不稳定骨盆骨折的病情特点，为临床救治时综合应用骨盆外固定支架、介入治疗、腹膜外填塞来控制骨盆出血提供初步依据。方法回顾性分析2005年1月至2012年1月间收治的31例血流动力学不稳定骨盆损伤患者资料。骨折按Tile分型：B型20例，C型11例。合并伤：脊柱四肢骨折18例，泌尿系统损伤14例，腹腔脏器损伤10例，颅脑损伤8例，胸腔脏器损伤6例，会阴撕裂伤6例。创伤严重度评分（injury severity score，ISS）ISS评分（38.6±13.6）分，31例患者来院后立刻采取损伤控制性复苏策略，采用骨盆外固定支架，介入治疗，或腹膜外填塞，来控制骨盆出血，术后持续复苏。结果治愈24例，死亡7例，病死率22.6%，其中4例死于失血性休克，2例死于MOF，1例死于肺栓塞。并发弥散性血管内凝血（dissemihated intravascular coagulation，DIC）7例，急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS）6例。结论在急救复苏过程中，对于血流动力学不稳定骨盆骨折患者采取损伤控制性复苏策略，综合应用骨盆外固定支架、介入治疗、腹膜外填塞来控制骨盆出血，可提高抢救成功率。
목적：총결화분석혈류동역학불은정골분골절적병정특점，위림상구치시종합응용골분외고정지가、개입치료、복막외전새래공제골분출혈제공초보의거。방법회고성분석2005년1월지2012년1월간수치적31례혈류동역학불은정골분손상환자자료。골절안Tile분형：B형20례，C형11례。합병상：척주사지골절18례，비뇨계통손상14례，복강장기손상10례，로뇌손상8례，흉강장기손상6례，회음시렬상6례。창상엄중도평분（injury severity score，ISS）ISS평분（38.6±13.6）분，31례환자래원후립각채취손상공제성복소책략，채용골분외고정지가，개입치료，혹복막외전새，래공제골분출혈，술후지속복소。결과치유24례，사망7례，병사솔22.6%，기중4례사우실혈성휴극，2례사우MOF，1례사우폐전새。병발미산성혈관내응혈（dissemihated intravascular coagulation，DIC）7례，급성호흡군박종합정（acute respiratory distress syndrome，ARDS）6례。결론재급구복소과정중，대우혈류동역학불은정골분골절환자채취손상공제성복소책략，종합응용골분외고정지가、개입치료、복막외전새래공제골분출혈，가제고창구성공솔。
[Objective] Objective To summary and analysis of the clinical data of hemodynamically unstable pelvic fracture, and to provide the preliminary findings for the emergency treatment of hemodynamically unstable pelvic fracture.Materials and Methods A retrospective study was performed on the clinical data of 31 pelvic fracture patients with unstable hemodynamics from January of 2005 to January of 2012.The types of fracture were decided by Tile system;among them,B:20 cases,C:11 cases,whose ISS(injury severity score)ran from(x±s)38.6±13.6.Associated injuries:combined spinal or limb Fracture in 18 Cases;combined urinary system injury in 14 Cases;combined abdominal organ injury in 10 cases;combined brain injury in 8 Cases;combined thoracic organ injured in 6 cases;combined perineal laceration in 6 cases.All 31 patients accepted restrictive volume resuscitation,and then underwent damage controled operation to control the bleeding by pelvic external fixator、interventional therapy or extraperitoneal pelvic packing. Results 24 patients recovered,4 patients died of bleeding,2 died of MOF,1 died of lung embolization.7 patients suffered disseminated intravascular coagulation,6 patients suffered acute respiratory distress syndrome. Conclusions In the emergent aid,the strategy of injury control and controling the bleeding by pelvic external fixator、interventional therapy or extraperitoneal pelvic packing could improve the rate of successful rescue in patients with unstable hemodynamics.