多即是少：脾脏损伤过去十年的管理策略已明确改变——一项基于全国人口的研究

More becomes less: management strategy has definitely changed over the past decade of splenic injury--a nationwide population-based study.

作者信息

Soo Kwan-Ming, Lin Tsung-Ying, Chen Chao-Wen, Lin Yen-Ko, Kuo Liang-Chi, Wang Jaw-Yuan, Lee Wei-Che, Lin Hsing-Lin

机构信息

Division of Trauma, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan ; Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan ; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan ; Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.

出版信息

Biomed Res Int. 2015;2015:124969. doi: 10.1155/2015/124969. Epub 2015 Jan 5.

DOI:10.1155/2015/124969

PMID:25629032

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4299358/

Abstract

BACKGROUND

Blunt spleen injury is generally taken as major trauma which is potentially lethal. However, the management strategy has progressively changed to noninvasive treatment over the decade. This study aimed to (1) find out the incidence and trend of strategy change; (2) investigate the effect of change on the mortality rate over the study period; and (3) evaluate the risk factors of mortality.

MATERIALS AND METHODS

We utilized nationwide population-based data to explore the incidence of BSI during a 12-year study period. The demographic characteristics, including gender, age, surgical intervention, blood transfusion, availability of CT scans, and numbers of coexisting injuries, were collected for analysis. Mortality, hospital length of stay, and cost were as outcome variables.

RESULTS

578 splenic injuries were recorded with an estimated incidence of 48 per million per year. The average 12-year overall mortality rate during hospital stay was 5.28% (29/549). There is a trend of decreasing operative management in patients (X (2), P = 0.004). The risk factors for mortality in BSI from a multivariate logistic regression analysis were amount of transfusion (OR 1.033, P < 0.001, CI 1.017-1.049), with or without CT obtained (OR 0.347, P = 0.026, CI 0.158-0.889), and numbers of coexisting injuries (OR 1.346, P = 0.043, CI 1.010-1.842).

CONCLUSION

Although uncommon of BSI, management strategy is obviously changed to nonoperative treatment without increasing mortality and blood transfusion under the increase of CT utilization. Patients with more coexisting injuries and more blood transfusion had higher mortality.

摘要

背景

钝性脾损伤通常被视为具有潜在致命性的重大创伤。然而，在过去十年中，治疗策略已逐渐转向非侵入性治疗。本研究旨在：（1）找出治疗策略改变的发生率和趋势；（2）调查研究期间治疗策略改变对死亡率的影响；（3）评估死亡的危险因素。

材料与方法

我们利用全国基于人群的数据，探讨了12年研究期间钝性脾损伤的发生率。收集了人口统计学特征，包括性别、年龄、手术干预、输血情况、CT扫描的可及性以及并存损伤的数量，用于分析。将死亡率、住院时间和费用作为结果变量。

结果

记录了578例脾损伤，估计每年每百万人口中有48例。住院期间12年的总体平均死亡率为5.28%（29/549）。患者接受手术治疗的趋势呈下降趋势（X(2)，P = 0.004）。多因素逻辑回归分析显示，钝性脾损伤患者死亡的危险因素包括输血量（OR 1.033，P < 0.001，CI 1.017 - 1.049）、是否进行CT检查（OR 0.347，P = 0.026，CI 0.158 - 0.889）以及并存损伤的数量（OR 1.346，P = 0.043，CI 1.010 - 1.842）。