[1]游建雄,王精兵,赵 庆,等.动脉栓塞联合外固定术治疗不稳定性骨盆骨折伴出血性休克效果分析 [J].介入放射学杂志,2021,30(05):493-497.
 YOU Jianxiong,WANG Jingbing,ZHAO Qing,et al.Transcatheter arterial embolization combined with external fixation for unstable pelvic fractures complicated by hemorrhagic shock: analysis of curative effect[J].journal interventional radiology,2021,30(05):493-497.
点击复制

动脉栓塞联合外固定术治疗不稳定性骨盆骨折伴出血性休克效果分析
()

PDF下载中关闭

分享到:

《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
30
期数:
2021年05
页码:
493-497
栏目:
临床研究
出版日期:
2021-05-25

文章信息/Info

Title:
Transcatheter arterial embolization combined with external fixation for unstable pelvic fractures complicated by hemorrhagic shock: analysis of curative effect
作者:
游建雄 王精兵 赵 庆 范新东
Author(s):
YOU Jianxiong WANG Jingbing ZHAO Qing FAN Xindong.
Department of Interventional Therapy, Affiliated Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 201999, China
关键词:
【关键词】 骨盆骨折 动脉栓塞 外固定术 血流动力学不稳定
文献标志码:
A
摘要:
【摘要】 目的 比较单纯外固定(EF)与血管栓塞(AE)联合EF治疗不稳定性骨盆骨折伴出血性休克患者的效果和安全性。方法 根据急诊治疗方法不同,将上海第九人民医院收治的不稳定性骨盆骨折伴出血性休克患者分为两组,2015年11月至2019年3月接受AE+EF术30例为治疗组,2011年3月至2015年10月接受单纯EF术30例患者为对照组。记录分析两组止血效果、输血量、重症监护室(ICU)治疗时间和院内死亡率,观察治疗组血管造影表现、手术成功率及术后并发症。 结果 术前治疗组与对照组间创伤严重度评分(ISS)、急诊室输红细胞量差异均无统计学意义(P>0.05)。两组患者手术均获成功。治疗组、对照组术后24 h分别输注红细胞(3.20±1.60)(2~6) U、(6.40±1.80)(4~10) U(P=0.012),总止血成功率分别为100%(30/30)、70%(21/30)(P=0.023),ICU治疗时间分别为(6.10±3.80)(2~10) d、(10.30±6.40)(2~20) d(P=0.017),死亡率分别为6.7%(2/30)、33.3%(10/30)(P=0.005),差异均有统计学意义。治疗组患者术后未出现AE相关严重并发症。 结论 AE+EF治疗不稳定性骨盆骨折伴出血性休克患者是安全的,与单纯EF相比临床疗效更显著,更能有效控制出血,死亡率更低,可作为早期急救首选方法。

参考文献/References:

[1] Grotz MR, Allami MK, Harwood P, et al. Open pelvic fractures: epidemiology, current concepts of management and outcome[J]. Injury, 2005, 36: 1-13.
[2] Schwartz DA, Medina M, Cotton BA, et al. Are we delivering two standards of care for pelvic trauma? Availability of angioem-bolization after hours and on weekends increases time to therapeutic intervention[J]. J Trauma Acute Care Surg, 2014, 76: 134-139.
[3] Perkins ZB, Maytham GD, Koers L, et al. Impact on outcome of a targeted performance improvement programme in haemodyna-mically unstable patients with a pelvic fracture[J]. Bone Joint J, 2014, 96: 1090-1097.
[4] Costantini TW, Coimbra R, Holcomb JB, et al. Current management of hemorrhage from severe pelvic fractures: results of an American Association for the Surgery of Trauma multi-institutional trial[J]. J Trauma Acute Care Surg, 2016, 80: 717-723.
[5] Cullinane DC, Schiller HJ, Zielinski MD, et al. Eastern association for the surgery of trauma practice management guidelines for hemorrhage in pelvic fracture: update and systematic review[J]. J Trauma, 2011, 71: 1850-1868.
[6] Cullinane DC, Schiller HJ, Zielinski MD, et al. Eastern Association for the Surgery of Trauma practice management guidelines for hemorrhage in pelvic fracture: update and systematic review[J]. J Trauma, 2011, 71:1850-1868.
[7] Tanizaki S, Maeda S, Matano H, et al. Time to pelvic embolization for hemodynamically unstable pelvic fractures may affect the survival for delays up to 60 min[J]. Injury, 2014, 45: 738-741.
[8] Vaidya R, Waldron J, Scott A, et al. Angiography and embolization in the management of bleeding pelvic fractures[J]. J Am Acad Orthop Surg, 2018, 26: e68- e76.
[9] 黄祥忠, 顾建平, 高 峰,等. 经导管动脉栓塞术治疗骨盆骨折大出血[J]. 介入放射学杂志, 2008, 17:166-168.
[10] Wang K, Zhou J, Chen XS, et al. Transcatheter arterial embolization for postoperative arterial complications after pelvic or hip surgery[J]. Diagn Interv Radiol, 2019, 25: 219-224.
[11] 沈国鑫,余景武,唐 杰,等. CO2-DSA在骨盆骨折大出血中的临床应用[J]. 介入放射学杂志, 2015, 24:713-716.
[12] Yoshihara H, Yoneoka D. Demographic epidemiology of unstable pelvic fracture in the United States from 2000 to 2009: trends and in-hospital mortality[J]. J Trauma Acute Care Surg, 2014, 76: 380-385.
[13] Riemer BL, Butterfield SL, Diamond DL, et al. Acute mortality associated with injuries to the pelvic ring: the role of early patient mobilization and external fixation[J]. J Trauma, 1993, 35: 671-675.
[14] Matsushima K, Piccinini A,Schellenberg M, et al. Effect of door- to- angioembolization time on mortality in pelvic fracture: every hour of delay counts[J]. J Trauma Acute Care Surg, 2018, 84: 685- 692.
[15] Lai YC, Wu CH, Chen HW, et al. Predictors of active arterial hemorrhage on angiography in pelvic fracture patients[J]. Jpn J Radiol, 2018, 36: 223-230.
[16] 中华医学会急诊医学分会, 中华医学会创伤学分会, 中国医师协会急诊医师分会, 等. 血流动力学不稳定骨盆骨折急诊处理专家共识[J]. 中华急诊医学杂志, 2015, 24:1314-1318.
[17] Matityahu A, Marmor M, Elson JK, et al. Acute complications of patients with pelvic fractures after pelvic angiographic embolization[J]. Clin Orthop Relat Res, 2013, 471: 2906-2911.
[18] Manson TT, Perdue PW, Pollak AN, et al. Embolization of pelvic arterial injury is a risk factor for deep infection after acetabular fracture surgery[J]. J Orthop Trauma, 2013, 27: 11-15.
[19] Firoozabadi R, Little M, Alton T, et al. Does pelvic embo-lization increase infection rates in patients who undergo open treatment of acetabular fractures?[J]. J Orthop Trauma, 2017, 31: 185-188.

相似文献/References:

[1]梁君.右肾母细胞瘤术前介入诊疗一例[J].介入放射学杂志,2000,(04):205.
[2]吴宁,杨进全,林道仲,等.宫颈癌髂内动脉灌注栓塞近期疗效分析[J].介入放射学杂志,1997,(01):47.
[3]卢武胜,刘文秀,刘畅,等.创伤性出血的急诊动脉栓塞治疗[J].介入放射学杂志,1999,(03):16.
[4]冯健麟.骨盆骨折并发动脉血栓形成一例[J].介入放射学杂志,1999,(03):8.
[5]杨宁,杨秀玉,刘巍,等.选择性子宫动脉插管在绒癌治疗中的应用[J].介入放射学杂志,1999,(04):209.
[6]罗来华,何远忠,周克,等.胆道大出血的介入放射学(附5例报告)[J].介入放射学杂志,1993,(01):13.
[7]刘传方,于光随,周亚军,等.在基层医院探索和实践开展介入放射学治疗几点体会[J].介入放射学杂志,1995,(02):75.
[8]杨永岩,林茂,吴纪瑞,等.髂股动脉栓塞的造影诊断[J].介入放射学杂志,1995,(03):165.
[9]夏彩凤,顾建平,楼文胜,等. 急性下肢动脉栓塞与血栓形成的临床异同分析[J].介入放射学杂志,2012,(05):369.
 ,,et al. Clinical factors useful for the differentiation of acute arterial embolism from acute arterial thrombosis of the lower extremities[J].journal interventional radiology,2012,(05):369.
[10]张 娣,顾建平.急性肢体缺血的介入治疗[J].介入放射学杂志,2011,(10):832.
 ZHANG Di,GU Jian-ping.Endovascular interventional therapy for acute limb ischemia[J].journal interventional radiology,2011,(05):832.
[11]沈国鑫,余景武,唐 杰,等.CO2- DSA在骨盆骨折大出血中的临床应用[J].介入放射学杂志,2015,(08):713.
 SHEN Guo- xin,YU Jing- wu,TANG Jie,et al.The clinical application of CO2- DSA in diagnosing massive hemorrhage due to pelvis fractures[J].journal interventional radiology,2015,(05):713.

备注/Memo

备注/Memo:
(收稿日期:2020-02-12)
(本文编辑:边 佶)
更新日期/Last Update: 2021-05-20