超选择性动脉栓塞术治疗骨盆骨折大出血的疗效评价
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作者Author单位AddressE-Mail
林正秋 LIN Zheng-qiu 温州医科大学附属第三医院骨科, 浙江 温州 325200 Department of Orthopaedics, the third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang, China  
叶秀芝 YE Xiu-zhi 温州医科大学附属第三医院骨科, 浙江 温州 325200 Department of Orthopaedics, the third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang, China  
王伟良 WANG Wei-liang 温州医科大学附属第三医院骨科, 浙江 温州 325200 Department of Orthopaedics, the third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang, China  
朱国庆 ZHU Guo-qing 温州医科大学附属第三医院骨科, 浙江 温州 325200 Department of Orthopaedics, the third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang, China  
谢秉局 XIE Bing-ju 温州医科大学附属第三医院骨科, 浙江 温州 325200 Department of Orthopaedics, the third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang, China  
刘良乐 LIU Liang-le 温州医科大学附属第三医院骨科, 浙江 温州 325200 Department of Orthopaedics, the third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang, China liuliangele@163.com 
期刊信息:《中国骨伤》2017年,第30卷,第12期,第1097-1101页
DOI:10.3969/j.issn.1003-0034.2017.12.005
基金项目:
中文摘要:

目的:探讨超选择性动脉栓塞术治疗骨盆骨折并发大出血的可行性与临床疗效。

方法:收集2008年3月至2016年2月诊治的65例骨盆骨折大出血患者的临床资料,将入选病例按是否行血管栓塞治疗分为非栓塞组与栓塞组,其中非栓塞组33例,男26例,女7例;年龄21~64(39.2±5.7)岁;受伤至入院时间1.1~4.8(2.2±0.4)h;根据AO/Tile分型,B型骨折12例,C型骨折21例;ISS评分25~42(37.7±7.5);休克指数评分1.7~2.4(2.1±0.3)分;以大量输血、补液为主。栓塞组32例,男25例,女7例;年龄22~65(38.1±4.5)岁;受伤至入院时间1.2~4.8(2.1±0.5)h;B型骨折14例,C型骨折18例;ISS评分26~43(38.9±4.5)分;休克指数评分1.6~2.4(2.2±0.2);在上述基础上加行超选择性动脉栓塞术。记录并比较两组患者的输血量、输液量、休克纠正时间和存活率,并记录栓塞组患者止血有效率和术中术后并发症。

结果:栓塞组造影发现损伤血管37支,患者在术后3 h内出血得到控制,血流动力学趋于稳定,栓塞组在输血量、输液量、休克纠正时间方面优于非栓塞组(P<0.00);栓塞组的存活率显著优于非栓塞组,差异有统计学意义(χ2=7.890,P=0.005);两组患者并发症比较差异有统计学意义(χ2=4.03,P=0.045)。

结论:超选择性动脉栓塞术治疗骨盆骨折大出血,止血精准高效、减少输血、输液量和休克发生率,提高患者存活率,值得临床推广。
【关键词】骨盆  骨折  出血  栓塞
 
Clinical effect of superselective arterial embolization for the treatment of massive haemorrhage from pelvic fracture
ABSTRACT  

Objective: To investigate feasibility and curative effect of superselective arterial embolization for the treatment of massive haemorrhage from pelvic fracture.

Methods: From March 2008 to February 2016,clinical data of 65 patients with massive haemorrhage from pelvic fracture were collected and analyzed,and patients were divided into non-embolic and embolic group according to whether perform vascular thrombosis. Thirty-three patients were in non-embolic group including 26 males and 7 females aged from 21 to 64 years old with an average of(39.2±5.7) years old,the time from injury to operation ranged from 1.1 to 4.8 h with an average of (2.2±0.4) h;12 cases were type B and 21 cases were type C according to AO/Tile classification;injury severity score (ISS) ranged from 25 to 42 with an average of (37.7±7.5);shock index score ranged from 1.7 to 2.4 with an average of 2.1±0.3;treated with blood transfusion and fluid infusion. Thirty-two patients in embolic group,including 25 males and 7 females aged from 22 to 65 years old with an average of(38.1±4.5) years old;the time from injury to operation ranged from 1.2 to 4.8 h with an average of (2.1±0.5) h;14 cases were type B and 18 cases were type C according to AO/Tile classification;ISS ranged from 26 to 43 with an average of 38.9±4.5;shock index score ranged from 1.6 to 2.4 with an average of 2.2±0.2;treated by blood transfusion and fluid infusion with superselective arterial embolization. Blood transfusion volume,fluid infusion volume,shock correction time and survival rate were observed and compared,effective rate of hemostasis and postoperative complications were compared.

Results: Thirty-seven artery were injured in embolic group,hemostasis were controlled at 3 h after operation,and hemodynamics turned to stable. There were significant difference in blood transfusion volume,fluid infusion volume,shock correction time between non-embolic and embolic group,and embolic group performed better. Survival rate in embolic group was also better than that of non-embolic group,and had significant difference. While there was obvious differences in complications(χ2=4.03,P=0.045).

Conclusion: Superselective arterial embolization for massive haemorrhage from pelvic fracture could effective hemostasis,reduce blood transfusion and fluid infusion volume and occurrence rate of shock,moreover improve survival rate and deserves promotion.
KEY WORDS  Pelvic  Fracture  Hemorrhage  Embolus
 
引用本文,请按以下格式著录参考文献:
中文格式:林正秋,叶秀芝,王伟良,朱国庆,谢秉局,刘良乐.超选择性动脉栓塞术治疗骨盆骨折大出血的疗效评价[J].中国骨伤,2017,30(12):1097~1101
英文格式:LIN Zheng-qiu,YE Xiu-zhi,WANG Wei-liang,ZHU Guo-qing,XIE Bing-ju,LIU Liang-le.Clinical effect of superselective arterial embolization for the treatment of massive haemorrhage from pelvic fracture[J].zhongguo gu shang / China J Orthop Trauma ,2017,30(12):1097~1101
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