Shatz David V
Department of Surgery, University of Miami School of Medicine, Florida 33101, USA.
J Trauma. 2002 Nov;53(5):950-6. doi: 10.1097/00005373-200211000-00023.
The purpose of this study was to examine trama surgeons' practice patterns regarding immunization of splenic injury patients.
Data were analyzed from surgeons responding to a survey sent to 557 adult trauma surgeons in the United States and Canada. The survey queried the timing and use of vaccinations in splenic injury patients.
Three hundred four (54.6%) surgeons responded to the survey, with 43 no longer active. Of the 261 active surgeons, 99.2% immunize their splenectomized patients, whereas 15.7% immunize those who undergo splenorrhaphy and 8.4% immunize those managed nonoperatively. Vaccines are administered anywhere from the immediate postoperative period to as long as 6 weeks later. All but two responding surgeons provide the pneumococcal vaccine, 62.8% also advocate meningococcal vaccination, 72.4% add the Haemophilus influenzae vaccine, and 56.7% give all three. Thirteen of the responding surgeons reimplant splenic tissue, most frequently in the omentum, and in quantities varying from two slices to the entire spleen. Revaccination practices are extremely varied-ranging from nothing at all to annually-and seldom follow Centers for Disease Control and Prevention guidelines.
With the exception of immunizing splenectomized patients against pneumococcal infection, little consensus exists among surgeons regarding the immunization of patients sustaining splenic injury.
本研究旨在调查创伤外科医生对脾损伤患者免疫接种的实践模式。
对回复一项针对美国和加拿大557名成年创伤外科医生的调查的外科医生的数据进行分析。该调查询问了脾损伤患者接种疫苗的时间和使用情况。
304名（54.6%）外科医生回复了调查，其中43名已不再执业。在261名仍在执业的外科医生中，99.2%会为接受脾切除的患者进行免疫接种，而15.7%会为接受脾修补术的患者进行免疫接种，8.4%会为非手术治疗的患者进行免疫接种。疫苗接种时间从术后即刻到长达6周不等。除两名回复的外科医生外，所有医生都提供肺炎球菌疫苗，62.8%的医生还提倡接种脑膜炎球菌疫苗，72.4%的医生会加用流感嗜血杆菌疫苗，56.7%的医生会三种疫苗都接种。13名回复的外科医生会进行脾组织再植入，最常见于大网膜，植入量从两片到整个脾脏不等。再次接种的做法差异极大，从根本不接种到每年接种都有，而且很少遵循疾病控制与预防中心的指南。
除了为脾切除患者预防肺炎球菌感染进行免疫接种外，外科医生对于脾损伤患者的免疫接种几乎没有达成共识。
