不同脾保留术对外伤性脾破裂失血性休克患者免疫功能的影响  

Effects of different splenic preserving techniques on immune function in patients with traumatic splenic rupture and hemorrhagic shock

作　　者：张伟[1] 

机构地区：[1]安徽省铜陵市人民医院急诊外科,244000

出　　处：《免疫学杂志》2017年第10期916-920,共5页Immunological Journal

摘　　要：目的研究不同脾保留术治疗外伤性脾破裂失血性休克的临床效果和对免疫功能影响。方法研究对象选取我院2015年1月至2017年2月间收治的外伤性脾破裂失血性休克患者85例,分别采用脾修补手术(40例,A组)和脾动脉栓塞术治疗(45例,B组),另选取同时间段的健康献血员40名作为C组。比较A、B组患者的手术时间、住院时间、输血量、抢救成功率、各项并发症发生率,同时比较A、B组患者术后T淋巴细胞水平变化并观察其与C组成员血中各T细胞水平的对比情况。结果B组的手术时间、住院时间、输血量均明显低于A组(P<0.01),B组的抢救成功率明显高于A组(χ~2=4.13,P=0.04);B组的总并发症发生率(4.44%)明显低于A组(25.00%)(χ~2=7.38,P<0.01);A、B组患者术后15 d和30 d的CD3^+、CD4^+、CD8^+、CD4^+/CD8^+水平均明显低于C组(P<0.05),B组术后15 d和30 d的CD3^+、CD4^+、CD4^+/CD8^+水平均明显高于A组(P<0.01)。结论脾动脉栓塞术治疗外伤性脾破裂失血性休克的安全性高,操作简单,同时创伤较小,可减少并发症的发生率,提高抢救成功率,且术后免疫功能恢复较快,值得在临床推广。To study the effects of different spleen preserving operation for traumatic splenic rupture andhemorrhagic shock on immune function, and its clinical effect, 85 cases of traumatic spleen rupture and hemorrhagicshock patients treated with spleen repair（40 cases, group A） or splenic artery embolization（45 cases, group B） in ourhospital from January 2015 to February 2017 were selected as the research objects, and 40 healthy blood donorswere selected as group C. Patients of groups A and B were compared in operation time, hospitalization time, bloodtransfusion volume, the success rate of rescue, and the incidence of complications. At the same time, the levels of Tlymphocytes were compared among groups of A, B, C. Data showed that the operation time, hospitalization time,blood transfusion volume of group B were significantly lower than those of group A（P〈0.01）, and the success rate ofrescue in group B was significantly higher than that of group A（ χ~2=4.13, P=0.04）; the total incidence ofcomplications in group B（4.44%） was significantly lower than that of group A（25%）（ χ~2=7.38, P〈0.01）.Furthermore, the CD3~＋, CD4~＋, CD8~＋, CD4~＋/CD8~＋levels of groups A and B were obviously lower than those of group C（P〈0.05）, while the CD3~＋, CD4~＋, CD4~＋/CD8~＋levels in group B at 15 d and 30 d psot operation were significantlyhigher that those in group A（P〈0.01）. In conclusion, splenic artery embolization in the treatment of traumaticsplenic rupture with hemorrhagic shock of high safety, simple operation, less trauma, can reduce the incidence ofcomplications and improve success rate of rescue, and recover postoperative immune function rapidly, thus which isworthy of clinical promotion.

关 键 词：脾修补手术 脾动脉栓塞术 外伤性脾破裂 失血性休克 免疫功能 

分 类 号：R657.62[医药卫生—外科学] R392.9[医药卫生—临床医学]