Wong L, Waxman K, Smolin M, Rypins E, Murdock M
Department of Surgery, Radiology, and Nursing, University of California, Irvine Medical Center, Orange 92668.
J Trauma. 1988 Apr;28(4):502-4. doi: 10.1097/00005373-198804000-00014.
To investigate the role of the IVP, we studied 139 patients with blunt abdominal trauma and hematuria. Multivariate analysis of clinical parameters was utilized in attempt to predict which patients would have abnormal IVP's and which would eventually require genitourinary operation. Thirty-four patients (25%) demonstrated abnormalities on IVP; however, no combination of clinical findings (including degree of hematuria) could reliably predict which patients would have abnormal IVP's. On the other hand, in 90% of the patients, the necessity for genitourinary operation could be reliably predicted based on: presence of blood at the urethral meatus, degree of hematuria, patient age, Injury Severity Score, and number of rib fractures. We conclude that to detect IVP abnormalities, IVP's need to be performed on all blunt trauma patients with hematuria. However, patients likely to have injuries requiring operative repair can be predicted. Those patients unlikely to have genitourinary injury requiring repair, therefore, may have IVP performed on a nonurgent basis.
为研究静脉肾盂造影（IVP）的作用，我们对139例腹部钝性创伤伴血尿的患者进行了研究。运用临床参数进行多变量分析，试图预测哪些患者的IVP会异常，以及哪些患者最终需要进行泌尿生殖系统手术。34例患者（25%）IVP显示异常；然而，没有任何临床发现的组合（包括血尿程度）能够可靠地预测哪些患者的IVP会异常。另一方面，在90%的患者中，基于以下因素可以可靠地预测泌尿生殖系统手术的必要性：尿道口有血、血尿程度、患者年龄、损伤严重度评分和肋骨骨折数量。我们得出结论，为检测IVP异常，需要对所有腹部钝性创伤伴血尿的患者进行IVP检查。然而，有可能存在需要手术修复损伤的患者是可以预测的。因此，那些不太可能有需要修复的泌尿生殖系统损伤的患者，可以在非紧急情况下进行IVP检查。
