钝性脾损伤的非手术治疗选择及实施策略探讨  

Discussion of the Selection and Strategy Implementation of Nonoperative Management for Blunt Splenic Injury

作　　者：李晓武[1] 尚培中[1] 贾国洪[1] 苗建军[1] 李永庆[1] 王金[1] 张伟[1] 

机构地区：[1]解放军251医院普通外科,河北张家口075000

出　　处：《临床误诊误治》2012年第9期43-45,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨钝性脾损伤的非手术治疗选择及实施策略。方法对我院2008年6月—2011年10月收治的钝性脾损伤82例的临床资料进行回顾性分析,重点对序列血红蛋白浓度监测及增强CT扫描监测非手术治疗效果进行讨论。结果本组67例血流动力学稳定,符合非手术治疗指征,其中54例经非手术治疗成功,成功率80.6%(54/67)。CT分级Ⅰ、Ⅱ级患者非手术治疗成功率为87.8%(36/41),Ⅲ级为63.6%(14/22)。13例非手术治疗失败,其中10例序列血红蛋白浓度测定持续下降。本组18例早期复查64排CT增强扫描,发现活动性出血3例,假性动脉瘤、肠系膜血管损伤各1例。结论对血流动力学稳定的钝性脾损伤患者,CT分级及序列血红蛋白浓度测定可用于监测非手术治疗的效果。CT分级Ⅰ、Ⅱ级患者非手术治疗成功率较高,增强CT有利于动态观察伤情变化。Objective To explore the selection and strategy implementation of nonoperative management （NOM） for blunt splenic injury （BSI）. Methods The clinical data of 82 patients with BSI during June 2008 and October 2011 were retrospectively analyzed. It was focused on the effectiveness of checking serial hemoglobin concentration and CT contrast enhanced scanning to observe the results of NOM. Results 67 patients with steady hemodynamies who fitted the nnnoperative indicatio curative were selected for the treatment of NOM. 54 patients had satisfactory nonoperative procedures and the achievement ratio was 80.6% （54/67）. The achievement ratio of the patients with CT grade Ⅰ or Ⅱ was 87.8% （36/41）, and 63.6% （14/22） in patients with CT grade Ⅲ. The NOM failed in 13 patients, including 10 with a continued decline in hemoglobin concentration. 18 patients by 64 rows CT contrast enhanced scanning in earlier callback were found 3 with active bleeding, 1 with pseudoaneurysm and 1 with mesenteric vessel injury. Conclusion CT grading and serial hemoglobin concentration check can test the efficiency of NOM in hemodynamically stable patients with BSI. The patients with CT grade Ⅰ or Ⅱhave a higher achievement ratio. Enhancement CT can facilitate the dynamic observation of traumatic development.

关 键 词：钝性脾损伤 非手术治疗 CT分级 序列血红蛋白浓度测定 

分 类 号：R657.62[医药卫生—外科学]