CAJ | 학술논문

目的探讨纱布填塞术控制血流动力学不稳定性骨盆骨折大出血的临床应用价值.方法选择2006年1月-2014年1月运用纱布填塞术治疗血流动力学不稳定性骨盆骨折患者42例,其中男23例,女19例;年龄18～ 54岁,平均34.2岁.按照AO分型:B1型9例,B2型5例,B3型3例,C1型13例,C2型4例,C3型8例,入院时所有患者均存在低血容量性休克,收缩压为(75.4±4.3) mmHg,心率为(126.5 ±12.4)次/min.损伤严重度评分(ISS)为(38.7±6.2)分.入院后及时给予抗休克治疗,骨盆束缚带临时固定骨盆,急诊给予骨盆容积控制及纱布填塞术.结果实施骨盆容积控制及纱布填塞术后,患者的收缩压为(95.2±4.6) mmHg,心率为(85.4±13.2)次/min,与术前比较差异有统计学意义(P＜0.05).纱布填塞术联合骨盆容积控制术前输红细胞(15.0 ±2.4)U,术后24 h输红细胞(8.3±1.5)U(P＜0.05).其中24例实施暂时性腹主动脉阻断术.死亡6例(14％).填塞纱布术后(51.4±10.3) h(24 ～ 168 h)拔出. 结论对于血流动力学不稳定性骨盆骨折患者,及时进行抗休克治疗,并采用纱布填塞术及骨盆容积控制,是一种控制骨盆骨折大出血的有效方法.
목적 탐토사포전새술공제혈류동역학불은정성골분골절대출혈적림상응용개치.방법 선택2006년1월-2014년1월운용사포전새술치료혈류동역학불은정성골분골절환자42례,기중남23례,녀19례;년령18～ 54세,평균34.2세.안조AO분형:B1형9례,B2형5례,B3형3례,C1형13례,C2형4례,C3형8례,입원시소유환자균존재저혈용량성휴극,수축압위(75.4±4.3) mmHg,심솔위(126.5 ±12.4)차/min.손상엄중도평분(ISS)위(38.7±6.2)분.입원후급시급여항휴극치료,골분속박대림시고정골분,급진급여골분용적공제급사포전새술.결과 실시골분용적공제급사포전새술후,환자적수축압위(95.2±4.6) mmHg,심솔위(85.4±13.2)차/min,여술전비교차이유통계학의의(P＜0.05).사포전새술연합골분용적공제술전수홍세포(15.0 ±2.4)U,술후24 h수홍세포(8.3±1.5)U(P＜0.05).기중24례실시잠시성복주동맥조단술.사망6례(14％).전새사포술후(51.4±10.3) h(24 ～ 168 h)발출. 결론 대우혈류동역학불은정성골분골절환자,급시진행항휴극치료,병채용사포전새술급골분용적공제,시일충공제골분골절대출혈적유효방법.
Objective To investigate the clinical value of gauze packing for haemodynamically unstable pelvic fracture.Methods Between January 2006 and January 2014,gauze packing was used to treat haemodynamically unstable pelvic fracture in 42 patients consisting of 23 males and the 19 females aged 34.2 years (range,18 to 54 years).AO classification of the fracture was type B1 in 9,B2 in 5,B3 in 3,C1 in 13,C2 in 4,and C3 in 8 patients.All the patients were diagnosed with hypovolemic shock upon admission with the systolic pressure of (75.4 ± 4.3) mmHg and heart rate of (126.5 ± 12.4) beats/ min.Injury severity score (ISS) was (38.7 ± 6.2)points.Anti-shock treatment,internal or external fixation of pelvic ring,and gauze packing were performed immediately to control the hemorrhage following pelvic fracture.Results Systolic pressure was (95.2 ± 4.6) mmHg and mean heart rate was declined to (85.4 ± 13.2)beats/min after pelvis volume control and gauze packing,with significant differences compared to these preoperatively (P ＜ 0.05).Red blood cell transfusion before internal or external fixation and gauze packing was (15.0 ± 2.4) units versus (8.3 ± 1.5) units within the first postoperative 24 hours (P ＜ 0.05).Twenty-four out of the 42 patients underwent temporary abdominal aorta occlusion.Six patients died postoperatively with the death rate of 14％.Mean time of removing the packing gauze was (51.4 ± 10.3) hours (range,24-168 hours).Conclusion Anti-shock treatment with concurrent gauze packing and pelvis volume control is effective to arrest the massive hemorrhage in hemodynamically unstable pelvic fracture.