Fangio Pascal, Asehnoune Karim, Edouard Alain, Smail Nadia, Benhamou Dan
Service d'Anesthésie-Réanimation et Unité Propre de Recherche de l'Enseignement Supérieur-Equipe d'Accueil, Hôpital de Bicêtre, Le Kremlin Bicêtre, France.
J Trauma. 2005 May;58(5):978-84; discussion 984. doi: 10.1097/01.ta.0000163435.39881.26.
In this retrospective study, we reviewed our protocol for management of hemodynamically unstable patients with pelvic injury.
We managed the patients with the same predetermined plan including controlled hemodynamic resuscitation with early use of vasopressors and pelvic angiography as a first-line treatment.
Of 311 patients with pelvic fracture, 32 hemodynamically unstable patients (10.3%) underwent pelvic angiography, which was followed by embolization in 25 cases. Angiography was successful for 24 patients (96%) and extrapelvic bleeding was diagnosed in 5 patients (15%). Three of six laparotomies performed before angiography were nontherapeutic. One of seven laparotomies performed after angiography was negative.
A protocol for management of patients with pelvic injury and hemodynamic instability that is associated with controlled resuscitation including vasopressor and early pelvic angioembolization is effective for treating pelvic hemorrhage and diagnosing extrapelvic hemorrhage. Further studies are needed to confirm the respective place of angiographic and surgical control of bleeding.
在这项回顾性研究中，我们回顾了对血流动力学不稳定的骨盆损伤患者的治疗方案。
我们按照相同的预定计划对患者进行治疗，包括控制性血流动力学复苏、早期使用血管升压药以及将骨盆血管造影作为一线治疗方法。
在311例骨盆骨折患者中，32例血流动力学不稳定患者（10.3%）接受了骨盆血管造影，其中25例随后进行了栓塞治疗。血管造影对24例患者（96%）成功，5例患者（15%）诊断为盆腔外出血。血管造影前进行的6次剖腹手术中有3次未起到治疗作用。血管造影后进行的7次剖腹手术中有1次结果为阴性。
对于伴有控制性复苏（包括使用血管升压药和早期骨盆血管造影栓塞）的骨盆损伤和血流动力学不稳定患者的治疗方案，在治疗骨盆出血和诊断盆腔外出血方面是有效的。需要进一步研究以确定血管造影和手术控制出血各自的作用。
Zotero 插件