血管栓塞治疗血流动力学不稳定伴骨盆骨折多发伤

摘要

目的：探讨血管造影及血管栓塞在血流动力学不稳定伴骨盆骨折多发伤中的作用。方法：选择18例血流动力学不稳定的严重多发伤伴有骨盆骨折患者，经必要的生命支持，维持基本生命体征，实施DSA血管造影及动脉栓塞术。18例患者中12例需机械通气，13例液体复苏同时需血管活性药物维持基本生命体征，6例血管造影前已行紧急手术。结果：18例经血管造影证实为髂内动脉及其分支出血。经血管栓塞后休克指数改善，酸中毒纠正、动脉血氧分压提高，每小时尿量明显增加。16例血流动力学不稳定状况改善；14例痊愈。结论：血管造影及血管内栓塞是救治血流动力学不稳定骨折的有效方法之一。%Objective:To investigate the clinical value of angiography and embolization in patients of multiple pelvic traumas with fractures and he-modynamic instability.Methods:Generally,18 severe multi-pelvic trauma patients with pelvic fractures and hemodynamic instability underwent con-secutive emergent life support care,digital subtraction angiography(DSA) and arterial embolization.Necessary mechanical ventilation was performed in 12 cases,and trauma fluid resuscitation was carried out with vasoactive agent to maintain the basic vital signs in 13.Another 6 required emergent surgery before DSA.Results:Eighteen patients were confirmed hemor-rhage of internal iliac artery and its branches by angiography ,and manage-ment by embolization led to improved shock indexes,corrected acidosis, elevated arterial partial pressure of oxygen ( PaO2 ) and significantly in-creased urine output per hour.Unstable hemodynamics was improved in 16 cases,and recovery occurred in 14.Conclusion:DSA associated with intravascular embolization appears one of the effective approaches to treat-ment of multiple pelvic trauma patients with fractures and hemodynamic instability.