Stanley A C, Vittemberger F, Napolitano L M, O'Hara K P, McGinnis K, Lockhart D, Silva W E
Department of Surgery, University of Massachusetts Medical Center, Worcester, USA.
Am Surg. 1999 Apr;65(4):369-74.
This purpose of this study was to analyze the use of abdominal computed tomography (CT) imaging in patients with possible blunt abdominal trauma. A retrospective analysis of all trauma patients over a 1-year period (1993-1994) was conducted, with prospective study protocol in 52 patients using serial abdominal exam and hematocrits (Hcts) instead of abdominal CT for evaluation of blunt abdominal trauma. Urgent abdominal CT was used as the initial diagnostic test for evaluation of blunt abdominal trauma in 813 patients over this 1-year period. CT was obtained in 379 (46.6%) of these patients who arrived hemodynamically stable (admission systolic blood pressure > or = 90), had a Glasgow Coma Scale > 13, and had admission Hct > or = 35 because of distracting injuries, possible traumatic brain injury, or alcohol/drug use, which might render the abdominal physical exam unreliable. Only 47 CT scans (12.4%) were positive, and three patients (0.8%) required laparotomy. In an effort to more efficiently use abdominal CT, we performed a prospective study in 52 patients with possible blunt abdominal trauma, admission systolic blood pressure > or = 90, Hct > or = 35, Glasgow Coma Scale > 13, and a normal abdominal exam on admission. These patients were followed with serial abdominal examinations and Hcts every 6 hours for 24 hours, and delayed CT, when applicable. CT was obtained in seven patients (13.5%) for evaluation of fall in Hct or abnormal abdominal examination; all were negative for abdominal injury. A protocol using serial abdominal exams, Hcts, and delayed abdominal CT imaging may be useful in select patients to decrease the high number of negative routine abdominal CTs that are obtained in the evaluation of blunt abdominal trauma.
本研究的目的是分析腹部计算机断层扫描（CT）成像在可能发生钝性腹部创伤患者中的应用情况。对1993 - 1994年这1年期间的所有创伤患者进行了回顾性分析，对52例患者采用前瞻性研究方案，通过连续腹部检查和血细胞比容（Hct）来评估钝性腹部创伤，而非使用腹部CT。在这1年期间，对813例钝性腹部创伤患者进行了紧急腹部CT检查，将其作为初始诊断测试。在这些患者中，379例（46.6%）血流动力学稳定（入院收缩压≥90）、格拉斯哥昏迷量表评分＞13且入院Hct≥35，因存在干扰性损伤、可能的创伤性脑损伤或酒精/药物使用，导致腹部体格检查不可靠，对这些患者进行了CT检查。只有47例CT扫描（12.4%）呈阳性，3例患者（0.8%）需要进行剖腹手术。为了更有效地使用腹部CT，我们对52例可能发生钝性腹部创伤、入院收缩压≥90、Hct≥35、格拉斯哥昏迷量表评分＞13且入院时腹部检查正常的患者进行了前瞻性研究。对这些患者每6小时进行连续腹部检查和Hct检测，持续24小时，必要时进行延迟CT检查。7例患者（13.5%）因Hct下降或腹部检查异常而进行了CT检查，所有患者腹部损伤均为阴性。对于某些患者，采用连续腹部检查、Hct检测和延迟腹部CT成像的方案可能有助于减少在钝性腹部创伤评估中获得的大量阴性常规腹部CT检查。
