Malhotra Ajai K, Latifi Rifat, Fabian Timothy C, Ivatury Rao R, Dhage S, Bee Tiffany K, Miller Preston R, Croce Martin A, Yelon Jay A
Department of Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, 23298, USA.
J Trauma. 2003 May;54(5):925-9. doi: 10.1097/01.TA.0000066182.67385.86.
The current study was undertaken to examine how concomitant injury to liver and spleen after blunt abdominal trauma affects management and outcomes.
This study was a retrospective chart review of all blunt abdominal trauma patients admitted with a diagnosis of liver or spleen injury at two Level I trauma centers over a 4-year period. Presentation, injury grade, management, and outcomes were analyzed. Patients with single-organ injury (liver or spleen) were compared with patients having injury to both organs (liver and spleen). Significance was set at 95% confidence intervals.
Of 1,288 patients who met entry criteria, 1,125 had single (spleen, 573; liver, 552) organ injury (group S) and 163 had injury to both organs (group B). Group B patients had significantly higher Injury Severity Score, higher admission lactate, and lower admission systolic blood pressure and base excess. Eighty-one percent (915 of 1,125) of group S and 69% (112 of 163) of group B patients were managed nonoperatively (p < 0.05). Of the nonoperatively managed patients, 5.8% (53 of 915) in group S and 11.6% (13 of 112) in group B failed this form of therapy (p < 0.05). Higher failure rate in group B was because of bleeding from injured solid organ(s), and not non-solid organ related failures. Mortality, intensive care unit and hospital lengths of stay, and transfusion requirements were all significantly higher in group B.
Blunt trauma patients with concomitant injury to liver and spleen have higher Injury Severity Score, mortality, lengths of stay, and transfusion requirements. There is a higher failure rate with nonoperative management, and therefore extra vigilance is warranted when choosing this form of therapy in the presence of injury to both organs.
本研究旨在探讨钝性腹部创伤后肝脏和脾脏的合并损伤如何影响治疗及预后。
本研究是一项回顾性图表审查，对4年间在两家一级创伤中心因诊断为肝脏或脾脏损伤而入院的所有钝性腹部创伤患者进行分析。分析患者的临床表现、损伤分级、治疗方法及预后。将单一器官损伤（肝脏或脾脏）患者与两个器官均有损伤（肝脏和脾脏）的患者进行比较。显著性设定为95%置信区间。
在符合入选标准的1288例患者中，1125例为单一器官损伤（脾脏573例，肝脏552例）（S组），163例为两个器官均有损伤（B组）。B组患者的损伤严重度评分显著更高，入院时乳酸水平更高，入院时收缩压和碱剩余更低。S组81%（1125例中的915例）和B组69%（163例中的112例）患者接受非手术治疗（p<0.05）。在接受非手术治疗的患者中，S组5.8%（915例中的53例）和B组11.6%（112例中的13例）这种治疗方式失败（p<0.05）。B组失败率更高是因为受伤实体器官出血，而非非实体器官相关的失败。B组的死亡率、重症监护病房和住院时间以及输血需求均显著更高。
肝脏和脾脏合并损伤的钝性创伤患者具有更高的损伤严重度评分、死亡率、住院时间和输血需求。非手术治疗失败率更高，因此在两个器官均有损伤时选择这种治疗方式时需要格外警惕。
