血管介入栓塞治疗骨盆骨折出血的止血效果  

Hemostatic efficacy of vascular interventional embolization for pelvic fractures with bleeding

作　　者：张明照 李博 秦荣清 张宇博 万辰宇 胡若宸 周兵[1] ZHANG Mingzhao;LI Bo;QIN Rongqing;ZHANG Yubo;WAN Chenyu;HU Ruochen;ZHOU Bing(Department of Interventional and Vascular Surgery,Afiliated Hospital of Hangzhou Normal University,Hangzhou,Zhejiang Province 310015,China)

机构地区：[1]杭州师范大学附属医院介入血管科,浙江杭州310015

出　　处：《介入放射学杂志》2023年第5期431-435,共5页Journal of Interventional Radiology

摘　　要：目的 探讨血管介入栓塞治疗骨盆骨折出血,尤其在血流动力学不稳定情况下的止血效果。方法 回顾性分析2018年1月至2021年12月在杭州师范大学附属医院接受血管介入栓塞止血治疗的26例骨盆骨折出血患者临床资料。比较治疗前后患者心率、收缩压、中心静脉压、休克指数、血乳酸盐5项血流动力学指标变化,评价治疗效果。结果 术后48 h内2例患者分别因重度颅脑损伤、休克后多脏器衰竭死亡,24例存活且血流动力学指标较术前明显改善。其中1例术后仍有活动性出血,48 h内行二次介入栓塞治疗后成功止血;2例术后分别出现一侧臀部皮肤肌肉软组织坏死、下肢足趾干性坏疽。结论 血管介入栓塞治疗骨盆骨折出血,尤其是血流动力学不稳定型盆骨骨折出血具有显著优势,术后止血效果良好,可作为临床急救止血的首选方法,值得推广。Objective To investigate the hemostatic effect of vascular interventional embolization in the treatment of pelvic fractures with hemorrhage,especially in the case of hemodynamic instability.Methods The clinical data of 26 patients with pelvic fracture complicated by hemorrhage,who were admitted to the Affiliated Hospital of Hangzhou Normal University of China to receive vascular interventional embolization treatment between January 2018 and December 2021,were retrospectively analyzed.Post-treatment five hemodynamic indicators,including heart rate,systolic blood pressure,central venous pressure,shock index and blood lactate,were compared with pre-treatment values.The treatment effect was evaluated.Results Within 48 hours after vascular interventional embolization,2 patients died of severe craniocerebral injury and multiple organ failure after shock separately.The other 24 patients survived and their hemodynamic indexes were improved significantly when compared with the preoperative values.Among the 24 patients,one patient still had active bleeding after treatment,a second interventional embolization treatment had to be carried out within 48 hours,and the bleeding was successfully stopped;2 patients developed soft tissue necrosis of the skin and muscles on unilateral hip and dry gangrene of the lower limbs respectively.Conclusion In treating pelvic fractures with bleeding,especially for the hemodynamically unstable pelvic fracture with bleeding,vascular interventional embolization has significant advantages with excellent hemostasis effect.It can be used as the preferred method for clinical emergency hemostasis and is worth popularizing in clinical practice.

关 键 词：骨盆骨折 血管造影 栓塞 止血 

分 类 号：R683.3[医药卫生—骨科学]