骨盆创伤中选择性栓塞与非选择性栓塞及不栓塞的比较：一项多中心回顾性队列研究。
Selective versus nonselective embolization versus no embolization in pelvic trauma: A multicenter retrospective cohort study.
作者信息
Hymel Aimee, Asturias Sabrina, Zhao Frank, Bliss Ryan, Moran Thea, Marshall Richard H, Benjamin Elizabeth, Phelan Herb A, Krause Peter C, Marecek Geoffrey S, Leonardi Claudia, Stuke Lance, Hunt John P, Mooney Jennifer L
机构信息
From the Department of Surgery, Louisiana State University Health Science Center, New Orleans, Louisiana; Department of Surgery, University of Southern California (S.A., E.B., G.S.M.), Los Angeles, California; and Department of Surgery, University of Texas Southwestern (F.Z., H.A.P.), Dallas, Texas.
出版信息
J Trauma Acute Care Surg. 2017 Sep;83(3):361-367. doi: 10.1097/TA.0000000000001554.
BACKGROUND
Traumatic hemorrhage from pelvic fractures is a significant challenge, and angioembolization has become standard. Optimal treatment is undefined in two clinical scenarios. The first is in the presence of a negative angiogram. Can arterial embolization treat venous bleeding by decreasing the arterial pressure head? If the angiogram is positive, is nonselective embolization (NSE) or selective embolization (SE) better? The purpose of this study is to determine if embolization after a negative angiogram aids in hemorrhage control and when the angiogram is positive, which level of embolization is superior?
METHODS
A multicenter retrospective review was conducted including blunt trauma patients with pelvic fractures who underwent angiography. Demographic and clinical data were compiled on all subjects. NSE refers to an intervention at the level of the internal iliac artery and SE is defined as any distal intervention. Theoretical complications of pelvic embolization are those thought to arise from decreased pelvic blood flow and will be referred to as embolization-related complications. Thromboembolic complications included deep vein thrombosis or pulmonary embolism.
RESULTS
One hundred ninety-four patients met inclusion criteria. Of the 67 patients with a negative angiogram, 26 (38.8%) were embolized. In those patients requiring transfusion, the units given in the first 24 hours were decreased in the embolization group (7.5 vs. 4.0, p = 0.054). Embolization-related complications occurred more frequently in those not embolized (11.4% vs. 6.0%, p = 0.414).One hundred forty-five patients were embolized, 99 (68.3%) NSE and 46 (31.7%) SE. There were no significant differences in mortality or transfusion requirements. There was no difference in the rate of embolization-related complications (4.1% vs. 2.1%, p = 0.352). There was a significantly increased rate of thromboembolic complications in the NSE group (12.1% vs. 0, p = 0.010).
CONCLUSION
Embolization in the face of a negative angiogram may aid in hemorrhage control for those patients being actively transfused. If embolized, then selective occlusion of more distal vessels rather than of the main internal iliac artery should be performed.
LEVEL OF EVIDENCE
Therapeutic, level IV.
背景
骨盆骨折导致的创伤性出血是一项重大挑战，血管栓塞术已成为标准治疗方法。在两种临床情况下，最佳治疗方案尚不明确。第一种情况是血管造影结果为阴性。动脉栓塞能否通过降低动脉压头来治疗静脉出血？如果血管造影结果为阳性，非选择性栓塞（NSE）还是选择性栓塞（SE）更好？本研究的目的是确定血管造影阴性后进行栓塞是否有助于控制出血，以及血管造影阳性时，哪种栓塞水平更具优势？
方法
进行了一项多中心回顾性研究，纳入了接受血管造影的骨盆骨折钝性创伤患者。收集了所有受试者的人口统计学和临床数据。NSE是指在髂内动脉水平进行的干预，SE定义为任何远端干预。骨盆栓塞的理论并发症是那些被认为由骨盆血流减少引起的并发症，将其称为栓塞相关并发症。血栓栓塞并发症包括深静脉血栓形成或肺栓塞。
结果
194例患者符合纳入标准。在67例血管造影结果为阴性的患者中，26例（38.8%）接受了栓塞治疗。在那些需要输血的患者中，栓塞组在最初24小时内输注的单位数有所减少（7.5对4.0，p = 0.054）。未接受栓塞治疗的患者栓塞相关并发症发生率更高（11.4%对6.0%，p = 0.414）。145例患者接受了栓塞治疗，99例（68.3%）为NSE，46例（31.7%）为SE。死亡率或输血需求方面无显著差异。栓塞相关并发症发生率无差异（4.1%对2.1%，p = 0.352）。NSE组血栓栓塞并发症发生率显著增加（12.1%对0，p = 0.010）。
结论
对于正在积极输血的患者，血管造影阴性时进行栓塞可能有助于控制出血。如果进行栓塞，应选择更远端血管而非髂内动脉主干进行选择性闭塞。
证据水平
治疗性，IV级。
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