Nonoperative treatment of multiple intra-abdominal solid organ injury after blunt abdominal trauma.

摘要

BACKGROUND: A number of large series' have attempted to examine the management of blunt solid organ injuries; however, only a few studies regarding multiple injuries exist. The aim of this study is to analyze whether multiple solid organ injury affects nonoperative management (NOM) and to look for predictive factors of NOM. METHODS: All patients admitted with a diagnosis of blunt solid organ injury between January 1, 1999 and January 1, 2005 were included in this prospective observational study. Of the 468 patients who had solid organ injury, 46 patients met the inclusion criteria of multiple solid organ injuries. Presentation, mechanism of injury, injury grade, Abbreviated Injury Scale score, management, and outcomes were analyzed. Independent predictive factors of NOM failure were identified. Patients managed nonoperatively were compared with patients who had had emergent laparotomy and patients for whom NOM failed. RESULTS: Fifteen patients (33%) underwent emergency laparotomy because of hypovolemicshock that was unresponsive to aggressive resuscitation, and 31 (66%) were selected for NOM. Among the 31 patients, NOM was successful in 23 (75%). No specific organ injury combination was found to affect NOM failure. Admission lactate level [odds ratio(OR), 1.44; 95% confidence interval (CI), 1.05-1.98; p = 0.025], a drop in the hematocrit greater than 20% in the first hour after admission (OR, 1.13; 95% confidence interval CI, 1.04-1.24; p = 0.007), and solid viscus score (OR, 1.67; 95% CI, 1.03-2.80; p = 0.04) were significant independent risk factors in those patients for whom NOM failed. In logistic regression analysis, hypotension at admission (OR, 0.96; 95% CI, 0.92-0.99; p = 0.014) and transfusion in the first 6 hours after admission (OR, 1.03; 95% CI, 1.00-1.05; p 0.015) were found to significantly affect the success rate of nonoperative management. CONCLUSION: Lactate levels at admission, solid viscus score, necessity of transfusion, crystalloid resuscitation, and a drop in the hematocrit in the first hour after admission are useful parameters for judging the failure of NOM. Although there is a higher failure rate of NOM in multiple solid organ injury, NOM can still be considered in these cases with extra caution.