临床、实验室及计算机断层扫描结果在识别无实质性器官损伤但有不明原因腹腔内游离液体的钝性创伤患者中空脏器损伤方面的准确性。

Accuracy of clinical, laboratory, and computed tomography findings for identifying hollow viscus injury in blunt trauma patients with unexplained intraperitoneal free fluid without solid organ injury.

作者信息

Jost Evan, Roberts Derek J, Penney Todd, Brunet Grant, Ball Chad G, Kirkpatrick Andrew W

机构信息

Department of Surgery, University of Calgary, Calgary, AB, Canada.

Department of Radiology, University of Calgary, Calgary, AB, Canada.

出版信息

Am J Surg. 2017 May;213(5):874-880. doi: 10.1016/j.amjsurg.2017.03.016. Epub 2017 Mar 23.

DOI:10.1016/j.amjsurg.2017.03.016

PMID:28351473

Abstract

BACKGROUND

We sought to define the accuracy of findings for detecting hollow viscus injury (HVI) in patients with blunt abdominal trauma (BAT) and unexplained intra-peritoneal free fluid without solid organ injury (UIPFFWSOI).

METHODS

We screened all consecutive hemodynamically stable patients presenting to a quaternary-care trauma-centre who had an abdominal computed tomography (CT) scan for BAT and UIPFFWSOI (January 2007-December 2014).

RESULTS

Of 3796 patients identified during the study period, 39 presented with UIPFFWSOI. Fifteen underwent therapeutic laparotomy. Seatbelt sign (+LR approaches infinity), diffuse peritonitis (+LR approaches infinity), number of CT cuts with fluid (c-statistic = 0.65), and a lower arterial pH at presentation (c-statistic = 0.62) were most predictive of HVI. Patients operated on within 24 h had shorter stays than those operated on later (median 9 vs. 14 days, p = 0.03).

CONCLUSIONS

Our findings suggest that clinical examination and measurements of intraperitoneal fluid volume may help identify HVIs in BAT patients.

摘要

背景

我们试图确定在钝性腹部创伤（BAT）且无实体器官损伤的不明原因腹腔内游离液体（UIPFFWSOI）患者中检测中空脏器损伤（HVI）的检查结果准确性。

方法

我们筛查了所有连续入住四级医疗创伤中心、因BAT和UIPFFWSOI接受腹部计算机断层扫描（CT）的血流动力学稳定患者（2007年1月至2014年12月）。

结果

在研究期间确定的3796例患者中，39例出现UIPFFWSOI。15例接受了治疗性剖腹手术。安全带征（阳性似然比接近无穷大）、弥漫性腹膜炎（阳性似然比接近无穷大）、有液体的CT扫描层数（c统计量 = 0.65）以及就诊时较低的动脉血pH值（c统计量 = 0.62）对HVI的预测性最强。在24小时内接受手术的患者住院时间比之后接受手术的患者短（中位数分别为9天和14天，p = 0.03）。