止血纱布填塞治疗肝切除术中不可控制性肝创面出血  

Hemostatic gauze packing in the treatment of uncontrollable massive hepatic hemorrhage during hepatectomy

作　　者：赵翎皓 崔勤 秦婴逸[3] 张金旻 高月 祁智 宋飞虹 汪珍光 刘福晨 刘辉 ZHAO Ling-hao;CUI Qin;QIN Ying-yi;ZHANG Jin-min;GAO Yue;QI Zhi;SONG Fei-hong;WANG Zhen-guang;LIU Fu-chen;LIU Hui(Department of Hepatic Surgery(Ⅲ),The Third Affiliated Hospital of Naval Medical University(Second Military MedicalUniversity),Shanghai 200438,China;Department of Anesthesiology,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai200080,China;Department of Military Health Statistics,Faculty of Health Services,Naval Medical University(Second Military MedicalUniversity),Shanghai 200433,China;Department of Critical Care,The Third Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200438,China;Department of Nephrology,The Third Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200438,China;Department of VIP Medicine,The Third Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200438,China)

机构地区：[1]海军军医大学(第二军医大学)第三附属医院肝外三科,上海200438 [2]上海交通大学医学院附属第一人民医院麻醉科,上海200080 [3]海军军医大学(第二军医大学)卫生勤务学系军队卫生统计学教研室,上海200433 [4]海军军医大学(第二军医大学)第三附属医院重症诊疗科,上海200438 [5]海军军医大学(第二军医大学)第三附属医院肾内科,上海200438 [6]海军军医大学(第二军医大学)第三附属医院特需诊疗科,上海200438

出　　处：《海军军医大学学报》2023年第1期21-27,共7页Academic Journal of Naval Medical University

基　　金：国家自然科学基金(82072759);中央军科委基础加强计划重点基础研究项目(2020-JC-JQ-ZD259-02);军队后勤科研项目;上海市青年科技启明星计划(20QA1412000);上海市“医苑新星”青年医学人才培养资助计划,海军军医大学(第二军医大学)启航人才计划;海军军医大学(第二军医大学)第三附属医院孟超人才计划。

摘　　要：目的总结止血纱布填塞治疗肝切除术中难以控制性大出血的经验与体会。方法回顾性分析2011年11月至2021年5月海军军医大学(第二军医大学)第三附属医院共120例行复杂肝切除术且术中同期行止血纱布填塞患者的临床资料,统计院内死亡率。根据是否发生院内死亡将患者分为未死亡组和死亡组,比较两组患者术前和术后血常规、凝血功能、肝功能等指标的差异。采用多因素logistic回归模型分析患者院内死亡的影响因素。结果仅10例患者发生院内死亡,死亡率为8.33%。120例患者分为未死亡组(n=110)和死亡组(n=10),死亡组患者术后第1天白蛋白、红细胞、血红蛋白、血小板、γ谷氨酰转肽酶低于未死亡组,并且术后第1天肌酐、国际标准化比值(INR)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)高于未死亡组(P均<0.05)。多因素logistic回归分析显示患者年龄、术后第1天PT和术后第1天APTT为患者院内死亡的独立影响因素。结论止血纱布填塞治疗肝切除术中难以控制大出血效果显著,操作方法简单,是一种实用有效的止血方法,值得临床推广。Objective To summarize the experience of hemostatic gauze packing in the treatment of uncontrollable massive hemorrhage during hepatectomy.Methods The clinical data of 120 patients who underwent complicated hepatectomy with hemostatic gauze packing in The Third Affiliated Hospital of Naval Medical University(Second Military Medical University)from Nov.2011 to May 2021 were retrospectively analyzed,and the in-hospital mortality was calculated.The patients were divided into non-death group and death group according to the occurrence of in-hospital death.The differences of blood routine,coagulation function,liver function and other indexes were compared between the 2 groups before and after operation.Multivariate logistic regression model was used to analyze the influencing factors of in-hospital death.Results Only 10 patients died in hospital,with a mortality of 8.33%.Patients were divided into non-death group(n=110)and death group(n=10).The albumin,red blood cells,hemoglobin,platelets,andγ-glutamyl transpeptidase of the patients in the death group were lower than those in the non-death group on the 1st day after operation,and the creatinine,international normalized ratio(INR),prothrombin time(PT)and activated partial thromboplastin time(APTT)were higher than those in the non-death group on the 1st day after operation(all P<0.05).Multivariate logistic regression analysis showed that the patient’s age,PT and APTT on the 1st day after operation were independent influencing factors for in-hospital death.Conclusion Hemostatic gauze packing has a significant effect for the treatment of massive hepatic hemorrhage during hepatectomy,and the operation technique is simple.It is a practical and effective method of hemostasis and is worthy of clinical promotion.

关 键 词：损伤控制性手术 止血纱布填塞 肝切除术 出血 

分 类 号：R657.3[医药卫生—外科学]