摘要
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.
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.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2014年第9期913-916,共4页
Chinese Journal of Trauma
基金
军区“十一五”计划资助项目（06MA78）
江西省卫生厅科技计划资助项目（20133234）
关键词
骨盆
骨折
失血性休克
剖腹探查术
Pelvis
Fractures, bone
Shock, hemorrhage
Laparotomy
