成人外伤性脾损伤治疗方式的选择  

Choice of treatment for adult splenic injury

作　　者：马西 宁登 杜鹏程 姜立 MA Xi;NING Deng;DU Peng-cheng(Department of Biliary and Pancreatic Surgery,The Tongji Hospital of Tongji Medical College,Huazhong University of Science and Technology Hubei Wuhan 430030)

机构地区：[1]华中科技大学同济医学院附属同济医院胆胰外科,湖北武汉430030

出　　处：《中国伤残医学》2020年第12期7-10,共4页Chinese Journal of Trauma and Disability Medicine

基　　金：国家自然科学基金资助项目(81472705)。

摘　　要：目的:研究影响脾损伤患者治疗方式和治疗效果的相关因素。方法:回顾性分析华中科技大学同济医学院附属同济医院2011年1月1日-2019年1月1日收治的脾损伤患者352例,手术治疗233例,保守治疗109例,脾动脉栓塞10例。比较手术治疗与非手术治疗患者间的临床资料,分析影响脾损伤患者治疗方式和治疗效果的相关因素。结果:单因素分析结果显示,手术治疗和非手术治疗组在住院时间、输血量、CT分级、腹腔积液量具有统计学差异(P<0.05)。在性别、年龄、入院时的生命体征(包括收缩压、心率、血红蛋白农度),2组之间差异无统计学意义(P>0.05)。多因素Logistic回归显示,患者住院时间(OR=1.902,P=0.003)、CT分级(OR=5.800,P=0.000)、腹腔积液量(OR=5.950,P=0.001)是影响非手术治疗失败的独立危险因素。非手术治疗的总体成功率为77.8%。结论:非手术治疗是外伤性脾损伤的的重要治疗方式,对于血流动力学稳定、腹腔积液阴性、CT分级1-3级的病人,在具有良好监测条件的中心可采取非手术治疗,脾动脉栓塞术有较好的治疗效果。Objective:To study the factors influencing the treatment and treatment effects of patients with spleen injury.Methods:A retrospective analysis of 352 cases of spleen injury patients admitted to Tongji Hospital affiliated to Huazhong University of Science and Technology from January 1,2011 to January 1,2019,233 cases of surgical treatment,109 cases of conservative treatment,10 cases of splenic artery embolization.To compare the clinical data between patients with surgical and non-surgical treatments,and to study the factors related to the treatment and treatment effects of patients with spleen injury.Results:Univariate analysis showed that patients were hospitalized for at least 1 U of red blood cells,CT grade,and peritoneal effusion during hospitalization(P<0.05).There were no significant differences in gender,age,and vital signs(including systolic blood pressure,heart rate,and hemoglobin concentration)between the two groups(P>0.05).Multivariate logistic regression showed that patients"hospital stay(OR=1.902,P=0.005),CT grade(OR=5.800,P=0.000),and peritoneal effusion volume(OR=5.950,P=0.001)were risk factors for nonoperative treatment treatment failure.The overall success rate for nonoperative treatment treatment was 77.8%.Conclusion:Nonoperative treatment was an important method for spleen injury.For patients with hemodynamic stability,negative peritoneal effusion,and good grades of CT grade 1-3,nonoperative treatment could be used.Splenic artery embolization had better treatment effect.

关 键 词：脾损伤 脾破裂 非手术治疗 

分 类 号：R657.6[医药卫生—外科学]