Gourlay David, Hoffer Eric, Routt Milton, Bulger Eileen
Department of Surgery, Harborview Medical Center, University of Washington, Seattle, Washington 98104, USA.
J Trauma. 2005 Nov;59(5):1168-73; discussion 1173-4. doi: 10.1097/01.ta.0000189043.29179.e4.
Angiography is the gold standard for the diagnosis and treatment of pelvic arterial hemorrhage associated with pelvic fractures. In most cases, a single angiogram with embolization is adequate to control pelvic arterial hemorrhage. However, a small subset of patients, require repeat pelvic angiogram to evaluate and treat recurrent hemorrhage. This study seeks to define this population and determine clinical predictors of recurrent hemorrhage.
We conducted a retrospective case control study comparing patients with traumatic pelvic fracture undergoing repeated pelvic angiogram versus a single angiogram between the years 1995 and 2000. Stepwise logistic regression was used to identify the independent predictors of recurrent hemorrhage.
In the years studied, 556 patients underwent a pelvic angiogram to evaluate for pelvic arterial hemorrhage associated with pelvic fractures. Among these, 42 (7.5%) patients underwent a second angiogram for suspected recurrent hemorrhage. In comparison to the initial angiogram, the source of bleeding on the repeat angiogram occurred at a new bleeding site in 68%, at a previously embolized site in 18%, and both in 14%. Significant risk factors for recurrent pelvic arterial hemorrhage included hypotension or transfusion of >2 U of blood per hour before the initial angiogram, pubic symphysis widening, and more than two injured arteries requiring embolization (p < 0.05). Of these, more than two injured arteries requiring embolization (odds ratio, 16.0; 95% confidence interval, 2.9-88) and transfusion of >2 U of blood per hour (odds ratio, 6.9; 95% confidence interval,1.9-25) were independent predictors of recurrent hemorrhage.
Angiographic control of traumatic pelvic arterial hemorrhage is highly successful. However, recurrent pelvic arterial hemorrhage does occur. We identified a subgroup of patients with pelvic fractures who are at increased risk of recurrent pelvic arterial hemorrhage and should be considered for early repeat angiography for signs of ongoing hemorrhage.
血管造影是诊断和治疗与骨盆骨折相关的盆腔动脉出血的金标准。在大多数情况下，单次血管造影加栓塞足以控制盆腔动脉出血。然而，一小部分患者需要重复进行盆腔血管造影以评估和治疗复发性出血。本研究旨在确定这一人群并确定复发性出血的临床预测因素。
我们进行了一项回顾性病例对照研究，比较了1995年至2000年间接受重复盆腔血管造影与单次血管造影的创伤性骨盆骨折患者。采用逐步逻辑回归来确定复发性出血的独立预测因素。
在所研究的年份中，556例患者接受了盆腔血管造影以评估与骨盆骨折相关的盆腔动脉出血。其中，42例（7.5%）患者因怀疑复发性出血而接受了第二次血管造影。与初次血管造影相比，重复血管造影时出血源发生在新的出血部位的占68%，发生在先前栓塞部位的占18%，两者都有的占14%。盆腔动脉复发性出血的显著危险因素包括初次血管造影前低血压或每小时输血超过2单位、耻骨联合增宽以及需要栓塞的受伤动脉超过两条（p<0.05）。其中，需要栓塞的受伤动脉超过两条（优势比，16.0；95%置信区间，2.9-88）和每小时输血超过2单位（优势比，6.9；95%置信区间，1.9-25）是复发性出血的独立预测因素。
创伤性盆腔动脉出血的血管造影控制非常成功。然而，盆腔动脉复发性出血确实会发生。我们确定了一组骨盆骨折患者，他们发生盆腔动脉复发性出血的风险增加，对于持续出血迹象应考虑早期重复血管造影。
