From the Los Angeles County + University of Southern California Medical Center, Los Angeles, California.
J Trauma Acute Care Surg. 2013 Oct;75(4):596-601. doi: 10.1097/TA.0b013e31829bb976.
Experimental data have demonstrated a potential survival benefit for animals undergoing splenectomy immediately after traumatic brain injury. The aim of this study was to investigate the effect of splenectomy on survival in patients with moderate or severe traumatic brain injury (TBI).
This is a National Trauma Data Bank (2002-2009) analysis and included patients sustaining moderate or severe blunt head trauma (head Abbreviated Injury Scale [AIS] score, 3-5), with an associated splenic injury and an exploratory laparotomy. The population was divided into two arms: those that had a splenectomy and those who did not. The primary outcome was in-hospital mortality. Logistic regression was performed to adjust for factors that were significantly different between the study groups.
During the 9-year study period, 2,625 patients met the criteria for inclusion in the analysis. Of these, 1,450 (55%) had a splenectomy, and 1,175 (45%) did not. Mortality was 13% for the splenectomized compared with 9% for the nonsplenectomized population (p = 0.001). After logistic regression, mortality remained significantly higher in the splenectomized population (adjusted odds ratio [AOR], 1.62; 95% confidence interval [CI], 1.16-2.26; p = 0.005). After stratification according to the severity of brain injury, the association between splenectomy and increased mortality persisted for both patients with moderate head injury (8% vs. 6%; AOR, 2.43; 95% CI, 1.26-4.71; p = 0.008) and for patients with severe head injury (17% vs. 10%; AOR, 1.49; 95% CI, 1.03-2.19; p = 0.036).
Splenectomy was independently associated with increased mortality in patients with moderate or severe TBI. This finding warrants further investigation regarding splenic preservation in patients with TBI.
Therapeutic study, level IV.
实验数据表明，创伤性脑损伤后立即行脾切除术的动物有潜在的生存获益。本研究旨在探讨脾切除术对中重度创伤性脑损伤（TBI）患者的生存影响。
这是一项国家创伤数据库（2002-2009 年）分析，纳入了中重度钝性头部创伤（头部损伤严重程度评分 [AIS] 3-5 分）伴脾脏损伤和剖腹探查的患者。人群分为两组：行脾切除术组和未行脾切除术组。主要结局为院内死亡率。采用 logistic 回归调整研究组间差异有统计学意义的因素。
在 9 年的研究期间，共有 2625 例患者符合纳入分析标准。其中 1450 例（55%）行脾切除术，1175 例（45%）未行脾切除术。脾切除组死亡率为 13%，未行脾切除组死亡率为 9%（p=0.001）。logistic 回归后，脾切除组死亡率仍显著升高（校正优势比 [AOR]，1.62；95%置信区间 [CI]，1.16-2.26；p=0.005）。根据脑损伤严重程度分层后，脾切除术与死亡率升高的相关性在中重度脑损伤患者中仍持续存在（中度脑损伤患者为 8%比 6%；AOR，2.43；95%CI，1.26-4.71；p=0.008）和重度脑损伤患者中（17%比 10%；AOR，1.49；95%CI，1.03-2.19；p=0.036）。
脾切除术与中重度 TBI 患者的死亡率增加独立相关。这一发现需要进一步研究 TBI 患者的脾脏保护。
治疗性研究，IV 级。
