在骨盆骨折栓塞前优化生命体征是否有益？复苏与止血之间的困境。

Is It Beneficial to Optimize Vital Signs Before Embolization for Pelvic Fractures? A Dilemma Between Resuscitation and Hemostasis.

机构信息

Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.

出版信息

Am Surg. 2023 May;89(5):1566-1573. doi: 10.1177/00031348211065119. Epub 2022 Jan 2.

DOI:10.1177/00031348211065119

PMID:34974733

Abstract

PURPOSE

Adequate resuscitation and definitive hemostasis are both important in the management of hemorrhage related to pelvic fracture. The goal of this study was to analyze the relationship between the amount of blood transfused before transcatheter arterial embolization (TAE) and the clinical outcome later in the disease course.

METHODS

Patients with pelvic fractures who underwent TAE for hemostasis from January 2018 to December 2019 were studied. The characteristics of patients who received blood transfusions of >2 U (1000 mL) and ≤2 U before TAE were compared. The mortality rate, blood transfusion-related complications, and length of stay were compared between these two groups.

RESULTS

Among the 75 studied patients, 39 (52.0%) received blood transfusions of ≤2 U before TAE, and the other 36 (48.0%) patients received blood transfusions of >2 U before TAE. The incidence rates of systemic inflammatory response syndrome, sepsis, and coagulopathy were significantly higher in the >2 U group (97.2% vs 81.1%, = .027; 50.0% vs 27.0%, = .045; and 44.4% vs 5.4%, < .01, respectively). After nonsurvivors were excluded, the >2 U group had a significantly higher proportion (43.8% vs 14.7%, < .001) of prolonged intensive care unit (ICU) length of stay (7 days or more) and a longer hospital length of stay (33.8 ± 15.1 vs 21.9 ± 94.0, < .01) than the ≤2 U group. Pre-TAE blood transfusion >2 U serves as an independent risk factor for prolonged ICU length of stay and increased hospital length of stay.

CONCLUSION

Early hemostasis for pelvic fracture-related hemorrhage is suggested to prevent pre-TAE blood transfusion-associated adverse effects of blood transfusion.

摘要

目的

在骨盆骨折相关出血的治疗中，充分的复苏和明确的止血都很重要。本研究的目的是分析经导管动脉栓塞术（TAE）前输血量与疾病后期临床结果之间的关系。

方法

研究了 2018 年 1 月至 2019 年 12 月因止血而行 TAE 的骨盆骨折患者。比较了 TAE 前输血量＞2 U（1000 mL）和≤2 U 的患者的特征。比较了两组患者的死亡率、输血相关并发症和住院时间。

结果

在 75 例研究患者中，39 例（52.0%）TAE 前输血量≤2 U，另 36 例（48.0%）患者 TAE 前输血量＞2 U。＞2 U 组全身炎症反应综合征、脓毒症和凝血障碍的发生率明显高于≤2 U 组（97.2%比 81.1%， =.027；50.0%比 27.0%， =.045；44.4%比 5.4%， <.01）。排除死亡患者后，＞2 U 组 ICU 住院时间延长（7 天或以上）的比例（43.8%比 14.7%， <.001）和住院时间延长（33.8±15.1 比 21.9±94.0， <.01）的比例明显高于≤2 U 组。TAE 前输血量＞2 U 是 ICU 住院时间延长和住院时间延长的独立危险因素。