CAJ | 학술논문

目的：探讨成人钝性脾损伤非手术治疗（ NOM ）失败的原因和危险因素。方法回顾性分析2011年11月～2014年3月间收治的110例钝性脾损伤成人患者，其中58例最初接受了非手术治疗，其中男性36例，女性22例；年龄17～89岁，平均（43.4±15.1）岁。根据治疗后期是否剖腹手术分为非手术治疗失败组和非手术治疗成功组，采用单因素分析和多因素Logistic回归法分析影响脾损伤非手术治疗结果的相关因素，确定脾损伤非手术治疗失败的独立危险因素。结果非手术治疗应用率为52.7％（58／110），其中失败率为24.14％（14／58），没有死亡发生。非手术治疗失败的主要原因：早期为活动性出血、早期再出血和脾损伤分级的误判，晚期为迟发性脾脏包膜下血肿破裂。单因素分析显示成人钝性脾损伤非手术治疗失败的相关因素有休克指数、腹腔积血程度、美国创伤外科协会（ AAST ）脾损伤分级、损伤严重程度评分（ISS）、新的损伤严重程度评分（NISS）、输注红细胞（RBC）量、住院时间（P＜0.05）。多因素Logistic回归分析发现AAST脾损伤分级≥3、中量或大量腹腔积血、输注RBC＞4U为NOM失败的独立危险因素。结论中量或大量腹腔积血，脾损伤≥3级和输注RBC＞4U为NOM失败的高危因素。
목적：탐토성인둔성비손상비수술치료（ NOM ）실패적원인화위험인소。방법회고성분석2011년11월～2014년3월간수치적110례둔성비손상성인환자，기중58례최초접수료비수술치료，기중남성36례，녀성22례；년령17～89세，평균（43.4±15.1）세。근거치료후기시부부복수술분위비수술치료실패조화비수술치료성공조，채용단인소분석화다인소Logistic회귀법분석영향비손상비수술치료결과적상관인소，학정비손상비수술치료실패적독립위험인소。결과비수술치료응용솔위52.7％（58／110），기중실패솔위24.14％（14／58），몰유사망발생。비수술치료실패적주요원인：조기위활동성출혈、조기재출혈화비손상분급적오판，만기위지발성비장포막하혈종파렬。단인소분석현시성인둔성비손상비수술치료실패적상관인소유휴극지수、복강적혈정도、미국창상외과협회（ AAST ）비손상분급、손상엄중정도평분（ISS）、신적손상엄중정도평분（NISS）、수주홍세포（RBC）량、주원시간（P＜0.05）。다인소Logistic회귀분석발현AAST비손상분급≥3、중량혹대량복강적혈、수주RBC＞4U위NOM실패적독립위험인소。결론중량혹대량복강적혈，비손상≥3급화수주RBC＞4U위NOM실패적고위인소。
Objective To explore the causes and risk factors of non-operative management ( NOM) fail-ure in adults with blunt splenic injury.Methods A total of 110 adults cases admitted from Nov.2011 to Mar.2014 with blunt splenic injury ( BSI) were reviewed retrospectively,among whom 58 patients received NOM initially.A-mong these patients,36 were male and 22 were female.The average age was (43.4 ±15.1) years(17-89 years). The patients were then divided into success group and failure group based on whether they were performed laparoto-my.Univariate and multivariate logistic analyses were performed to investigate correlative factors affecting the out-come of NOM in adults with BSI and to identify independent risk factors of NOM failure.Results The rate of NOM was 52.7%(58/110).The rate of NOM failure was 24.14%(14/58) and no death occurred.The main causes of failure were active bleeding,early rebleeding and incorrect classification of splenic injuries in the early stage and de-layed subcapsular hematoma in the late stage.Univariate analysis revealed that factors associated with NOM failure in patients with BSI were shock index, degree of hemoperitoneum, grade of splenic injury, injury severity score ( ISS) ,new injury severity score( NISS) ,amount of transfused RBCs as well as hospitalization period( length of hos-pital stay),(P<0.05).Multivariate logistic regression analysis showed that the presence of moderate or large hae-moperitoneum,higher-grade splenic injury(AAST grade 3-5)and transfusion of more than 4U of RBCs were inde-pendent predictors of NOM failure.Conclusion Moderate or large haemoperitoneum,higher-grade splenic injury and transfusion of more than 4U of RBCs are high risk factors for NOM failure in adults with blunt splenic injury.