Lin Zheng-Qiu, Ye Xiu-Zhi, Wang Wei-Liang, Zhu Guo-Qing, Xie Bing-Ju, Liu Liang-le
Department of Orthopaedics, the third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang, China.
Department of Orthopaedics, the third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang, China;
Zhongguo Gu Shang. 2017 Dec 25;30(12):1097-1101. doi: 10.3969/j.issn.1003-0034.2017.12.005.
To investigate feasibility and curative effect of superselective arterial embolization for the treatment of massive haemorrhage from pelvic fracture.
From March 2008 to February 2016, clinical data of 65 patients with massive haemorrhage from pelvic fracture were collected and analyzed, and patients were divided into non-embolic and embolic group according to whether perform vascular thrombosis. Thirty-three patients were in non-embolic group including 26 males and 7 females aged from 21 to 64 years old with an average of(39.2±5.7) years old, the time from injury to operation ranged from 1.1 to 4.8 h with an average of (2.2±0.4) h; 12 cases were type B and 21 cases were type C according to AO/Tile classification; injury severity score (ISS) ranged from 25 to 42 with an average of (37.7±7.5); shock index score ranged from 1.7 to 2.4 with an average of 2.1±0.3; treated with blood transfusion and fluid infusion. Thirty-two patients in embolic group, including 25 males and 7 females aged from 22 to 65 years old with an average of(38.1±4.5) years old; the time from injury to operation ranged from 1.2 to 4.8 h with an average of (2.1± 0.5) h; 14 cases were type B and 18 cases were type C according to AO/Tile classification; ISS ranged from 26 to 43 with an average of 38.9±4.5; shock index score ranged from 1.6 to 2.4 with an average of 2.2±0.2; treated by blood transfusion and fluid infusion with superselective arterial embolization. Blood transfusion volume, fluid infusion volume, shock correction time and survival rate were observed and compared, effective rate of hemostasis and postoperative complications were compared.
Thirty-seven artery were injured in embolic group, hemostasis were controlled at 3 h after operation, and hemodynamics turned to stable. There were significant difference in blood transfusion volume, fluid infusion volume, shock correction time between non-embolic and embolic group, and embolic group performed better. Survival rate in embolic group was also better than that of non-embolic group, and had significant difference. While there was obvious differences in complications(χ²=4.03, =0.045).
Superselective arterial embolization for massive haemorrhage from pelvic fracture could effective hemostasis, reduce blood transfusion and fluid infusion volume and occurrence rate of shock, moreover improve survival rate and deserves promotion.
探讨超选择性动脉栓塞术治疗骨盆骨折大出血的可行性及疗效。
收集2008年3月至2016年2月65例骨盆骨折大出血患者的临床资料并分析，根据是否行血管栓塞分为非栓塞组和栓塞组。非栓塞组33例，男26例，女7例，年龄21～64岁，平均（39.2±5.7）岁，受伤至手术时间1.1～4.8 h，平均（2.2±0.4）h；按AO/Tile分类，B型12例，C型21例；损伤严重度评分（ISS）25～42分，平均（37.7±7.5）分；休克指数评分1.7～2.4，平均2.1±0.3；给予输血、补液治疗。栓塞组32例，男25例，女7例，年龄22～65岁，平均（38.1±4.5）岁；受伤至手术时间1.2～4.8 h，平均（2.1±0.5）h；按AO/Tile分类，B型14例，C型18例；ISS 26～43分，平均38.9±4.5分；休克指数评分1.6～2.4，平均2.2±0.2；给予输血、补液及超选择性动脉栓塞术治疗。观察比较两组患者的输血量、补液量、休克纠正时间及生存率，比较止血有效率及术后并发症。
栓塞组共栓塞37支动脉，术后3 h止血，血流动力学趋于稳定。非栓塞组与栓塞组在输血量、补液量、休克纠正时间方面差异有统计学意义，栓塞组效果更好。栓塞组生存率也高于非栓塞组，差异有统计学意义。并发症方面差异有统计学意义（χ²=4.03，P=0.045）。
超选择性动脉栓塞术治疗骨盆骨折大出血能有效止血，减少输血量及补液量，降低休克发生率，提高生存率，值得推广。
