中华创伤杂志
中華創傷雜誌
중화창상잡지
Chinese Journal of Traumatology
2014年
9期
913-916
,共4页
黄薇%陈自力%宋景春%邓星平%宋晓敏
黃薇%陳自力%宋景春%鄧星平%宋曉敏
황미%진자력%송경춘%산성평%송효민
骨盆%骨折%失血性休克%剖腹探查术
骨盆%骨摺%失血性休剋%剖腹探查術
골분%골절%실혈성휴극%부복탐사술
Pelvis%Fractures,bone%Shock,hemorrhage%Laparotomy
目的 探讨早期两种止血方案对骨盆骨折合并失血性休克患者临床疗效的影响.方法 对2008年1月—2012年12月抢救治疗90例不稳定骨盆骨折合并失血性休克患者进行回顾性分析,初期均进行损害控制性液体复苏后血压不稳定并伴有腹部膨隆.A组40例自2008年1月至2010年1月行剖腹探查双侧髂内动脉结扎术;B组50例自2010年2月至2012年12月行经髂内动脉栓塞介入术.比较两组患者的病死率、24 h输血量、24 h乳酸值、术后血压、术后体温、术后凝血酶原时间(prothrombin time,PT)等. 结果 两组患者病死率(A组为53％,B组为12％)、24 h输血量[A组为(3 865.5±451.3)ml,B组为(2 108.8 ±336.4)ml]、24 h乳酸值[A组为(13±2.0)mmol/L,B组为(5.4±1.2) mmol/L]、术后收缩压[A组为(80.5±22.7) mmHg,B组为(113.2±20.9) mmHg]、术后体温[A组为(32.4±0.2)℃,B组为(36.1±0.3)℃]、术后PT[A组为(24.5±3.6)s,B组为(18.4±2.1)s]差异均有统计学意义(P＜0.05). 结论 在骨盆骨折合并失血性休克抢救治疗中,在没有明确腹腔脏器破裂指征情况下,首选介入栓塞术较剖腹探查术具有提高患者救治成功率、降低病死率及减少并发症的优势.
目的 探討早期兩種止血方案對骨盆骨摺閤併失血性休剋患者臨床療效的影響.方法 對2008年1月—2012年12月搶救治療90例不穩定骨盆骨摺閤併失血性休剋患者進行迴顧性分析,初期均進行損害控製性液體複囌後血壓不穩定併伴有腹部膨隆.A組40例自2008年1月至2010年1月行剖腹探查雙側髂內動脈結扎術;B組50例自2010年2月至2012年12月行經髂內動脈栓塞介入術.比較兩組患者的病死率、24 h輸血量、24 h乳痠值、術後血壓、術後體溫、術後凝血酶原時間(prothrombin time,PT)等. 結果 兩組患者病死率(A組為53％,B組為12％)、24 h輸血量[A組為(3 865.5±451.3)ml,B組為(2 108.8 ±336.4)ml]、24 h乳痠值[A組為(13±2.0)mmol/L,B組為(5.4±1.2) mmol/L]、術後收縮壓[A組為(80.5±22.7) mmHg,B組為(113.2±20.9) mmHg]、術後體溫[A組為(32.4±0.2)℃,B組為(36.1±0.3)℃]、術後PT[A組為(24.5±3.6)s,B組為(18.4±2.1)s]差異均有統計學意義(P＜0.05). 結論 在骨盆骨摺閤併失血性休剋搶救治療中,在沒有明確腹腔髒器破裂指徵情況下,首選介入栓塞術較剖腹探查術具有提高患者救治成功率、降低病死率及減少併髮癥的優勢.
목적 탐토조기량충지혈방안대골분골절합병실혈성휴극환자림상료효적영향.방법 대2008년1월—2012년12월창구치료90례불은정골분골절합병실혈성휴극환자진행회고성분석,초기균진행손해공제성액체복소후혈압불은정병반유복부팽륭.A조40례자2008년1월지2010년1월행부복탐사쌍측가내동맥결찰술;B조50례자2010년2월지2012년12월행경가내동맥전새개입술.비교량조환자적병사솔、24 h수혈량、24 h유산치、술후혈압、술후체온、술후응혈매원시간(prothrombin time,PT)등. 결과 량조환자병사솔(A조위53％,B조위12％)、24 h수혈량[A조위(3 865.5±451.3)ml,B조위(2 108.8 ±336.4)ml]、24 h유산치[A조위(13±2.0)mmol/L,B조위(5.4±1.2) mmol/L]、술후수축압[A조위(80.5±22.7) mmHg,B조위(113.2±20.9) mmHg]、술후체온[A조위(32.4±0.2)℃,B조위(36.1±0.3)℃]、술후PT[A조위(24.5±3.6)s,B조위(18.4±2.1)s]차이균유통계학의의(P＜0.05). 결론 재골분골절합병실혈성휴극창구치료중,재몰유명학복강장기파렬지정정황하,수선개입전새술교부복탐사술구유제고환자구치성공솔、강저병사솔급감소병발증적우세.
Objective To compare the clinical effect of two hemostatic methods for patients with pelvic fracture combined with hemorrhagic shock in the early stage.Methods A retrospective analysis was done on clinical data of 90 patients with unstable pelvic fracture combined with hemorrhagic shock managed by damage control resuscitation from January 2008 to December 2012.Unstable blood pressure and abdominal distension were noted postoperatively.Forty patients in Group A received laparotomy and bilateral internal iliac artery ligation from January 2008 to January 2010.Fifty patients in Group B underwent internal iliac artery embolization from February 2010 to December 2012.Comparative measurement was made on parameters of mortality,24-hour blood transfusion volume,24-hour lactic acid value,postoperative systolic blood pressure,postoperative body temperature,and postoperative prothrombin time (PT).Results Following parameters differed significantly between Groups A and B (P ＜ 0.05):mortality rate (53％ vs 12％),24-hour blood transfusion volume[(3 865.5 ±451.3)ml vs (2 108.8 ±336.4)ml],24-hour lactic acid value[(13.0 ± 2.0)mmol/L vs (5.4 ± 1.2)mmol/L],postoperative systolic blood pressure [(80.50 ± 22.73) mmHg vs (113.23 ± 20.89) mmHg],postoperative body temperature [(32.4 ± 0.2)℃ vs (36.1 ±0.3)℃],postoperative PT [(24.5 ±3.6)s vs (18.4±2.1)s].Conclusion For pelvic fracture combined with hemorrhagic shock,if the indications of abdominal viscera rupture are unclear,the interventional embolization can gain advantage over laparotomy in improving treatment success rate and reducing mortality and complications.
