Division of Trauma, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan.
Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taiwan.
Int J Surg. 2019 Sep;69:116-123. doi: 10.1016/j.ijsu.2019.07.033. Epub 2019 Jul 31.
The nonoperative management (NOM) protocol with angioembolization (AE) presents a trend in dealing with trauma patients with blunt splenic injury (BSI). This study was designed to explore the adverse events and associated risk factors before and after protocol-based NOM of BSI over a 12-year period.
A retrospective study was performed on adult trauma patients with BSI who were admitted from 2005 to 2016. The patients were divided into before cohort (2005-2010) and after cohort (2011-2016). Multivariate logistic regression analysis was performed to identify risk factors associated with the morbidity. The primary outcomes are NOM-related mortality and total number of complications, the secondary outcome is the incidence of each complication.
The before cohort was composed of 209 patients, and the after cohort had 190 patients. There was a significant increase in the use of AE (from 18.1% to 47.5%, p < 0.001) with a higher incidence of patients who had a shock episode before AE (from 4.2% to 16.5%, p < 0.001). Regarding the outcomes, there were no significant differences in the incidences of NOM-related mortality between the after than before cohorts. However, there were 190 complications in 71 patients in the before cohort but 289 complications in 73 patients in the after cohort. The incidence of complications was significantly higher in the group of after cohort than the group of before cohort. Regarding the complications, the patients in the after cohort were significantly more likely to have adverse events of coagulopathy, acidosis, hyperbilirubinemia, respiratory failure, and acute kidney injury than those in the before cohort.
Strict adherence to the NOM protocol in treating patients with BSI without adequate patient selection increased not only the use of NOM but also the possibility of complications and failed to significantly improve the clinical outcomes.
血管内栓塞术（AE）的非手术治疗（NOM）方案在处理钝性脾损伤（BSI）的创伤患者方面呈现出一种趋势。本研究旨在探讨 12 年来基于方案的 BSI NOM 前后的不良事件和相关危险因素。
对 2005 年至 2016 年期间收治的成人 BSI 创伤患者进行回顾性研究。患者分为前组（2005-2010 年）和后组（2011-2016 年）。采用多变量逻辑回归分析确定与发病率相关的危险因素。主要结局是 NOM 相关死亡率和总并发症数，次要结局是每种并发症的发生率。
前组有 209 例患者，后组有 190 例患者。AE 的使用率显著增加（从 18.1%增加到 47.5%，p<0.001），AE 前发生休克的患者比例也显著增加（从 4.2%增加到 16.5%，p<0.001）。就结果而言，后组与前组之间，NOM 相关死亡率的发生率没有显著差异。然而，前组 71 例患者有 190 种并发症，而后组 73 例患者有 289 种并发症。后组的并发症发生率明显高于前组。关于并发症，后组患者发生凝血功能障碍、酸中毒、高胆红素血症、呼吸衰竭和急性肾损伤等不良事件的可能性明显高于前组。
在没有充分选择患者的情况下严格遵守 NOM 方案治疗 BSI 患者，不仅增加了 NOM 的使用，而且增加了发生并发症的可能性，且未能显著改善临床结局。
