目的 比较纱布填塞术与造影栓塞术在骨盆骨折大出血治疗中的效能.方法 回顾性分析2004年4月至2012年4月治疗43例骨盆骨折大出血的患者资料.按照骨盆骨折的救治流程进行救治,其中26例应用纱布填塞术(填塞组),17例应用造影栓塞术(栓塞组).填塞组26例,男15例,女11例;平均年龄41.6岁;车祸伤12例,坠落伤8例,砸伤6例;骨盆骨折Tile分型:B型16例,C型10例,其中4例为开放性骨盆骨折,5例伴有腹部脏器损伤.栓塞组17例,男10例,女7例;平均年龄39.2岁;车祸伤9例,坠落伤5例,砸伤3例;骨盆骨折Tile分型:A型2例,B型11例,C型4例.比较两组患者的创伤严重程度评分(ISS)、手术时间、输血量、并发症等.结果 填塞组平均ISS评分为(52.4±15.3)分,栓塞组为(40.6±12.4)分;填塞组平均手术时间为(42.0±2.1) min,栓塞组为(86.0±3.6)min;填塞组术后24 h内输血量平均为(6.0±1.6)U,栓塞组为(10.0±2.1)U;填塞组ICU住院时间平均为(8.0±3.6)d,栓塞组为(11.0±1.8)d;以上指标两者比较差异均有统计学意义.填塞组术前输血量平均为(15.0±4.7)U,栓塞组为(13.0±5.4)U,两者比较差异无统计学意义.填塞组2例行二次纱布填塞止血,栓塞组6例行二次纱布填塞治疗.填塞组术后5例死亡,无因大出血而死亡的患者;栓塞组术后4例死亡,1例因大出血而于术后32 h死亡.填塞组3例患者术后7～9d发生深部感染,其中1例于术后第16天死亡,另2例与栓塞组1例(术后第9天发生浅表感染)经换药处理后好转.结论 纱布填塞术较造影栓塞术手术时间短,止血效果确切,可明显减少术后输血量、ICU住院时间及术后的死亡率,更适用于我国国情及基层医院的骨盆骨折出血的抢救.%Objective To compare the efficiency of the pelvic packing and the angioembolization for controlling pelvic fracture hemorrhoea.Methods Data of 43 consecutive patients with pelvic fracture hemorrhoea who were enrolled in our hospital from April 2004 to April 2012 were retrospectively analyzed.There were 26 patients who had undergone pelvic packing,including 15 men and 11 women with an average age of 41.6 years (packing group).The causes of the fractures included road accident injury (12 cases),falling injury (8 cases) and the bruise injury caused by heavy object (6 cases).According to the Tile classification,there were 16 cases of type B and 10 cases of type C.There were 4 cases with open pelvic fractures and 5 associated with the abdomen trauma.There were 17 patients who had undergone angioembolization,including 10 men and 7 women,with an average age of 39.2 years (angio group).The causes included road accident injury (9 cases),falling injury (5 cases) and the bruise injury caused by heavy object (3 cases).There were 2 cases of type A,11 cases of type B and 4 cases of type C.The ISS,operation time,blood transfusion and the complication were all recorded respectively.Results For the packing group,the average ISS was 52.4± 15.3,and the operation time was 42.0±2.1 min.The blood transfusion was 15.0±4.7 U before the surgery and 6.0±1.6 U in the first 24 h after the surgery.The mean ICU stay was (8.0±3.6)d.And for the angio group,the average ISS was 40.6±12.4,and the operation time was 86.0±3.6 min.The blood transfusion before the surgery was 13.0±5.4 U vs.10.0±2.1 U in the first 24 h after the surgery,and the ICU stay was 11.0± 1.8 d.2 cases in the packing group underwent repacking and 6 cases in the angio group had received second angioembolization.Five cases died in the packing group but no one died of the hemorrhoea while 4 cases died in the angio group with one died of the hemorrhoea.There were 3 cases in the packing group suffering the deep infection while 1 suffered the superficial infection in the angio group.Conclusion The efficiency of the pelvic packing is higher than the angioembolization because of its shorter operation time and ICU stay,more effective blood control,less blood transfusion after surgery,and lower postoperative mortality.It is very suitable for the application at the local hospital and the national conditions nowadays.
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