成人钝性脾损伤非手术治疗效果的影响因素分析
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摘要
目的分析成人钝性脾损伤非手术治疗的影响因素。方法成人钝性脾损伤病人96例。根据入院时的病情,51例病人行非手术治疗。根据非手术组治疗成功与否,分为非手术失败组和非手术治疗成功组。采用单因素和Logistics回归法分析影响非手术治疗效果的影响因素。结果非手术治疗的应用率为53. 1%(51/96),其中非手术治疗成功率为76. 5%(39/51),23. 5%(12/51)的病人中转手术治疗。单因素分析显示,非手术治疗的主要影响因素包括全身损伤程度评分(ISS)、美国创伤外科协会评分(AAST)、腹腔积液量、最低收缩压、最快脉搏搏动、最快心率、最低血红蛋白、红细胞输注量、住院时间、并发症发生率。Logistics回归分析显示,ISS评分、AAST分级、腹腔积液量、最低收缩压、最快脉搏搏动、最快心率和最低血红蛋白、输注红细胞量是非手术治疗效果的独立影响因素。结论非手术治疗成人钝性脾损伤的成功率较高,但应严格纳入病例,并熟悉掌握中转手术的指征。
Objective To investigate the influencing factors for failures of non-operative management in adults with blunt splenic injury. Methods A total of 96 adult patients with blunt splenic injury were selected. According to patient's condition,non-operative management was performed in 51 patients.According to the treatment was successful or not,they were divided into non-operative failure group and non-operation group. Single factor and logistics regression analysis were used to analyze the influence factors of the success of non-operative treatment. Results The application rate of non-operative treatment was 53. 1%( 51/96),of which the success rate of non-operative treatment was 76. 5%( 39/51),while the remaining 23. 5%( 12/51) patients were converted to surgical treatment. Single factor analysis showed that the main influencing factors of success were ISS score,AAST classification,volume of ascites,the lowest systolic blood pressure,the fastest pulse,the fastest heart rate,the lowest hemoglobin,amount of transferred erythrocyte,hospitalization time and complication rate. Logistics regression analysis revealed that ISS score,AAST classification,volume of ascites,the lowest systolic blood pressure,the fastest pulse,the fastest heart rate,the lowest hemoglobin and amount of transferred erythrocyte were independent factors affecting the success of non-surgical treatment. Conclusion The success rate of non-operative treatment for adult blunt splenic injury is high. Case inclusion must be strict,and the indication of converting to surgical treatment must be strictly mastered.
Objective To investigate the influencing factors for failures of non-operative management in adults with blunt splenic injury. Methods A total of 96 adult patients with blunt splenic injury were selected. According to patient's condition,non-operative management was performed in 51 patients.According to the treatment was successful or not,they were divided into non-operative failure group and non-operation group. Single factor and logistics regression analysis were used to analyze the influence factors of the success of non-operative treatment. Results The application rate of non-operative treatment was 53. 1%( 51/96),of which the success rate of non-operative treatment was 76. 5%( 39/51),while the remaining 23. 5%( 12/51) patients were converted to surgical treatment. Single factor analysis showed that the main influencing factors of success were ISS score,AAST classification,volume of ascites,the lowest systolic blood pressure,the fastest pulse,the fastest heart rate,the lowest hemoglobin,amount of transferred erythrocyte,hospitalization time and complication rate. Logistics regression analysis revealed that ISS score,AAST classification,volume of ascites,the lowest systolic blood pressure,the fastest pulse,the fastest heart rate,the lowest hemoglobin and amount of transferred erythrocyte were independent factors affecting the success of non-surgical treatment. Conclusion The success rate of non-operative treatment for adult blunt splenic injury is high. Case inclusion must be strict,and the indication of converting to surgical treatment must be strictly mastered.
引文
[1]谢方亮,李伟,葛夏青,等.成人钝性脾损伤的非手术治疗[J].中华普通外科杂志,2015,30(7):538-540.
[2]吴耀华,代文杰.保脾手术的适应证问题[J].临床外科杂志,2014,22(8):545-546.
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[7]戴丐国,杜根安,马红梅.钝性脾损伤非手术治疗经验[J].中华外科杂志,2009,47(2):86-88.
[8]李晓武,尚培中,贾国洪,等.钝性脾损伤的非手术治疗选择及实施策略探讨[J].临床误诊误治,2012,25(9):43-45.
[9]Brillantino A,Iacobellis F,Robustelli U,et al.Non operative management of blunt splenic trauma:a prospective evaluation of a standardized treatment protocol[J].Eur J Trauma Emerg Surg,2016,42(5):593-598.
[10]Tanaka C,Tagami T,Matsumoto H,et al.Recent trends in 30-day mortality in patients with blunt splenic injury:A nationwide trauma database study in Japan[J].Plos One,2017,12(9):e0184690.
[11]宁辰,朱东波,龚辉,等.成人钝性脾损伤非手术治疗失败的危险因素研究[J].创伤外科杂志,2015,17(3):202-206.
[12]魏元明,冯延昌,栾学荣.钝性脾损伤的非手术治疗[J].中华肝胆外科杂志,2000,6(5):25.
[13]Cadeddu M,Garnett A,Al-Anezi K,et al.Management of spleen injuries in the adult trauma population:a ten-year experience[J].Canadian Journal of Surgery,2006,49(6):386.
[14]汪谦,姜洪池,李宗芳.脾脏损伤治疗方式的专家共识(2014版)[J].临床肝胆病杂志,2015,31(2):1002-1003.
[15]陈强谱,王庆华.脾损伤的非手术治疗[J].中华急诊医学杂志,2005,14(3):258-259.
[2]吴耀华,代文杰.保脾手术的适应证问题[J].临床外科杂志,2014,22(8):545-546.
[3]Scarborough JE,Ingraham AM,Liepert AE,et al.Nonoperative Management Is as Effective as Immediate Splenectomy for Adult Patients with High-Grade Blunt Splenic Injury[J].J Am Coll Surg,2016,223(2):249-258.
[4]Olthof DC,Pieter J,Bossuyt PMM,et al.Observation Versus Embolization in Patients with Blunt Splenic Injury After Trauma:A Propensity Score Analysis[J].World J Surg,2016,40(5):1264-1271.
[5]Rajani RR,Claridge JA,Yowler CJ,et al.Improved outcome of adult blunt splenic injury:a cohort analysis[J].Surgery,2006,140(4):625-631.
[6]苏震东,吴巨钢,倪晓春,等.成人钝性脾损伤88例治疗分析[J].上海交通大学学报(医学版),2007,27(8):933-936.
[7]戴丐国,杜根安,马红梅.钝性脾损伤非手术治疗经验[J].中华外科杂志,2009,47(2):86-88.
[8]李晓武,尚培中,贾国洪,等.钝性脾损伤的非手术治疗选择及实施策略探讨[J].临床误诊误治,2012,25(9):43-45.
[9]Brillantino A,Iacobellis F,Robustelli U,et al.Non operative management of blunt splenic trauma:a prospective evaluation of a standardized treatment protocol[J].Eur J Trauma Emerg Surg,2016,42(5):593-598.
[10]Tanaka C,Tagami T,Matsumoto H,et al.Recent trends in 30-day mortality in patients with blunt splenic injury:A nationwide trauma database study in Japan[J].Plos One,2017,12(9):e0184690.
[11]宁辰,朱东波,龚辉,等.成人钝性脾损伤非手术治疗失败的危险因素研究[J].创伤外科杂志,2015,17(3):202-206.
[12]魏元明,冯延昌,栾学荣.钝性脾损伤的非手术治疗[J].中华肝胆外科杂志,2000,6(5):25.
[13]Cadeddu M,Garnett A,Al-Anezi K,et al.Management of spleen injuries in the adult trauma population:a ten-year experience[J].Canadian Journal of Surgery,2006,49(6):386.
[14]汪谦,姜洪池,李宗芳.脾脏损伤治疗方式的专家共识(2014版)[J].临床肝胆病杂志,2015,31(2):1002-1003.
[15]陈强谱,王庆华.脾损伤的非手术治疗[J].中华急诊医学杂志,2005,14(3):258-259.