Lee Woosung, Shim Yu Shik, Chung Joonho
Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea.
J Cerebrovasc Endovasc Neurosurg. 2016 Jun;18(2):83-89. doi: 10.7461/jcen.2016.18.2.83. Epub 2016 Jun 30.
The purpose of this study was to report our preliminary experience with endovascular treatment (EVT) for life-threatening bleeding from branches of the external carotid artery (ECA) in patients with traumatic maxillofacial fractures.
A total of 12 patients seen between March 2010 and December 2014 were included in this study. All subjects met the following criteria: 1) presence of maxillofacial fracture; 2) continuous blood loss from oronasal bleeding; and 3) EVT to stop bleeding. Various clinical factors were recorded for each patient and the correlations between those factors and clinical outcome (Glasgow Outcome Scale, GOS) were evaluated.
Four patients were injured in traffic accidents, five in falls, and three by assaults. Mean initial Glasgow Coma Scale (GCS) was 6.9 ± 2.1 and the lowest hemoglobin measured was mean 6.3 ± 0.9 g/dL. GOS at discharge was 4 in five patients, 3 in three patients, and 1 (death) in four patients. GOS on follow-up (mean 13.7 months) was 5 in two patients, 4 in three patients, and 3 in three patients. Initial GCS ( = 0.016), lowest systolic blood pressure ( = 0.011), and lowest body temperature ( = 0.012) showed a significant positive correlation with good clinical outcomes. The number of units of red blood cells transfused ( = 0.030), the number of units of fresh frozen plasma transfused ( = 0.013), and the time from arrival to groin puncture ( < 0.001) showed significant negative correlation with good clinical outcomes.
It might be suggested that rapid transition to EVT could be preferable to struggling with other rescue strategies to stop life-threatening bleeding from branches of the ECA in patients with traumatic maxillofacial fractures.
本研究的目的是报告我们对创伤性颌面骨折患者颈外动脉（ECA）分支危及生命的出血进行血管内治疗（EVT）的初步经验。
本研究纳入了2010年3月至2014年12月期间诊治的12例患者。所有受试者均符合以下标准：1）存在颌面骨折；2）口鼻持续出血；3）采用EVT止血。记录每位患者的各种临床因素，并评估这些因素与临床结局（格拉斯哥预后评分，GOS）之间的相关性。
4例患者因交通事故受伤，5例因跌倒受伤，3例因袭击受伤。初始格拉斯哥昏迷量表（GCS）平均为6.9±2.1，测得的最低血红蛋白平均为6.3±0.9 g/dL。出院时GOS评分为4分的患者有5例，3分的患者有3例，1分（死亡）的患者有4例。随访时（平均13.7个月）GOS评分为5分的患者有2例，4分的患者有3例，3分的患者有3例。初始GCS（P = 0.016）、最低收缩压（P = 0.011）和最低体温（P = 0.012）与良好的临床结局呈显著正相关。输注红细胞的单位数（P = 0.030）、输注新鲜冰冻血浆的单位数（P = 0.013）以及从到达至腹股沟穿刺的时间（P < 0.001）与良好的临床结局呈显著负相关。
对于创伤性颌面骨折患者，快速转向EVT可能比采用其他抢救策略来制止ECA分支危及生命的出血更为可取。
