Tyagunov A E, Trudkov D Y, Polyaev A Y, Stradymov E A, Baglaenko M V, Mosin S V, Sazhin A V
Department of Faculty Surgery No. 1, Pirogov Russian National Research Medical University (Pirogov Medical University), Ostrovityanova Str., 1, Moscow, Russia, 117997.
Moscow Multidisciplinary Clinical Center "Kommunarka", P. Kommunarka, Sosenskij Stan Str., 8, Moscow, Russia, 108814.
Sci Rep. 2025 Jan 16;15(1):2145. doi: 10.1038/s41598-025-85454-9.
Spontaneous bleeding into soft tissues was a common complication of anticoagulant therapy among critically ill patients during the COVID-19 pandemic. This study sought to evaluate the impact of different treatment methods on survival among COVID-19 patients with active or self-resolved spontaneous bleeding into soft tissues. Methods used to treat CT-confirmed spontaneous hematomas in COVID-19 patients included nonoperative management (NOM), angiography (AG) with transarterial embolization (TAE) and open surgery (OS). A total of 227 participants with spontaneous hematomas into soft tissues were enrolled in this retrospective single-center study at a COVID-19-hospital between March 3, 2020 and March 3, 2022. NOM was used in 144 patients, including 51 patients with extravasation on CT; 60 patients with extravasation on CT were subjected to AG, which was followed by TAE in 41 patients. Open surgery was performed on 23 patients. The choice of treatment strategy did not have any effect on 30-day mortality among patients with extravasation. Mortality did not differ between the OS, NOM and AG/AG+TAE groups (p = 0.094). In the multivariate logistic regression model, OS and NOM did not increase the risk of death, in comparison with AG, respectively (OR 1.53 [95% CI: 0.35-7.37]; p = 0.579 and OR 1.39 [95% CI: 0.53-3.72]; p = 0.501).
在新冠疫情期间，软组织自发性出血是重症患者抗凝治疗的常见并发症。本研究旨在评估不同治疗方法对新冠病毒感染且伴有软组织活动性或已自行消退的自发性出血患者生存情况的影响。治疗新冠病毒感染患者CT确诊的自发性血肿的方法包括非手术治疗（NOM）、血管造影（AG）联合经动脉栓塞术（TAE）和开放手术（OS）。在一家新冠定点医院进行的这项回顾性单中心研究中，共纳入了227例软组织自发性血肿患者，研究时间为2020年3月3日至2022年3月3日。144例患者采用非手术治疗，其中51例CT显示有外渗；60例CT显示有外渗的患者接受了血管造影，其中41例随后接受了经动脉栓塞术。23例患者接受了开放手术。对于有外渗的患者，治疗策略的选择对30天死亡率没有任何影响。开放手术组、非手术治疗组和血管造影/血管造影联合经动脉栓塞术组之间的死亡率没有差异（p = 0.094）。在多因素逻辑回归模型中，与血管造影相比，开放手术和非手术治疗分别不会增加死亡风险（比值比1.53 [95%可信区间：0.35 - 7.37]；p = 0.579和比值比1.39 [95%可信区间：0.53 - 3.72]；p = 0.501）。
