Aiolfi Alberto, Inaba Kenji, Strumwasser Aaron, Matsushima Kazuhide, Grabo Daniel, Benjamin Elizabeth, Lam Lydia, Demetriades Demetrios
Division of Trauma & Surgical Critical Care (A.A., K.I., A.S., K.M., D.G., E.B., L.L., D.D.), University of Southern California, LAC+USC Medical Center, Los Angeles, California.
J Trauma Acute Care Surg. 2017 Sep;83(3):356-360. doi: 10.1097/TA.0000000000001550.
Splenic artery embolization (SAE) has gained increasing acceptance as an important adjunct in the treatment of splenic injuries. Residual immunologic function of the spleen after embolization and its consequences on early infectious complications still remain intensely debated. The purpose of this study was to compare SAE and splenectomy (SP) in terms of early in-hospital infectious complications and outcomes.
Two-year retrospective Trauma Quality Improvement Program database prognostic study. Patients with grade IV to V splenic injury requiring SAE or SP were included in the final analysis. Examined variables were demographics, mechanism of injury, Abbreviated Injury Scale (AIS), Injury Severity Score, Organ Injury Scale, admission vital signs, blood transfusion in the first 24 hours, early infectious complications, and outcomes. Multivariate analysis adjusted for patient and injury-related variables was used to identify independent predictors for infectious complication and mortality.
During the study period, 4,063 patients with a grade IV to V splenic injury managed with SAE or SP were included in the study. SAE was performed in 461 (11.3%) patients. The early infectious complication rate was 23.1% in the SP group and 11.7% in the SAE group (p < 0.001). Stepwise logistic regression analysis identified age 65 years or older, Glasgow Coma Scale (GCS) score less than 9, Head AIS score of 3 or greater, SP, and blood transfusion in the first 24 hours as independent predictors for early infectious complications. The unadjusted overall mortality was 12.7% in the SP group and 5.4% in the SAE group (p < 0.001). Age 65 years or older, GCS score less than 9, hypotension, head AIS score of 3 or greater, and blood transfusion in the first 24 hours were independent risk factor for mortality. SP was not an independent risk factor in terms of mortality. Subgroup analysis in patients with isolated splenic injury showed age 65 years or older, GCS score less than 9, and blood transfusion in the first 24 hours as independent factors associated with early infection.
Our study supports the effectiveness of SAE in hemodynamically stable patients with a grade IV to V splenic injury. SP is associated with an increased risk of early infectious complications but is not an independent risk for mortality.
Therapeutic study, level IV.
脾动脉栓塞术（SAE）作为脾损伤治疗的重要辅助手段，越来越受到认可。栓塞后脾脏的残余免疫功能及其对早期感染并发症的影响仍存在激烈争论。本研究的目的是比较SAE和脾切除术（SP）在早期院内感染并发症和预后方面的差异。
一项为期两年的回顾性创伤质量改进计划数据库预后研究。最终分析纳入需要SAE或SP的IV至V级脾损伤患者。检查的变量包括人口统计学、损伤机制、简明损伤量表（AIS）、损伤严重程度评分、器官损伤量表、入院生命体征、24小时内输血情况、早期感染并发症和预后。采用对患者和损伤相关变量进行调整的多变量分析来确定感染并发症和死亡率的独立预测因素。
在研究期间，4063例接受SAE或SP治疗的IV至V级脾损伤患者纳入研究。461例（11.3%）患者接受了SAE。SP组早期感染并发症发生率为23.1%，SAE组为11.7%（p<0.001）。逐步逻辑回归分析确定年龄65岁及以上、格拉斯哥昏迷量表（GCS）评分低于9、头部AIS评分为3或更高、SP以及24小时内输血是早期感染并发症的独立预测因素。SP组未经调整的总死亡率为12.7%，SAE组为5.4%（p<0.001）。年龄65岁及以上、GCS评分低于9、低血压、头部AIS评分为3或更高以及24小时内输血是死亡的独立危险因素。就死亡率而言，SP不是独立危险因素。对孤立性脾损伤患者进行亚组分析显示，年龄65岁及以上、GCS评分低于9以及24小时内输血是与早期感染相关的独立因素。
我们的研究支持SAE对血流动力学稳定的IV至V级脾损伤患者的有效性。SP与早期感染并发症风险增加相关，但不是死亡的独立危险因素。
治疗性研究，IV级。
