纱布填塞术治疗骨盆骨折大出血  

Gauze packing for massive hemorrhage in pelvic fracture

作　　者：杨永良[1] 周东生[1] 王鲁博[1] 王伯珉[1] 李连欣[1] 王永会[1] 董金磊[1] 

机构地区：[1]山东大学附属省立医院,山东省骨科医院创伤骨科,济南250021

出　　处：《中华创伤杂志》2015年第6期521-525,共5页Chinese Journal of Trauma

摘　　要：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24h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（24～168h）拔出。结论对于血流动力学不稳定性骨盆骨折患者，及时进行抗体克治疗，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。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 unsta- ble pelvic fracture.

关 键 词：骨盆 骨折 出血 外科纱布 损伤控制 

分 类 号：R687.3[医药卫生—骨科学]