外伤性脾破裂高危因素分析.docVIP

外伤性脾破裂高危因素分析 　　摘要：目的 通过回顾成人外伤性脾脏损伤的临床资料，探讨腹部CT结合脾破裂评分等多种高危因素在腹部闭合伤脾破裂患者诊治中的价值，用以分析影响脾破裂的高危因素。方法 通过回顾性分析，收集2012年2月～2015年2月期间贵阳医学院急诊外科例腹部闭合伤脾破裂患者，制定纳入及排除标准，其中收集病例45例，收集共14项影响因素：性别、年龄、受伤现场情况、受伤机制、体温、心率、血压、腹腔内脏器合并伤、腹部CT、脾破裂分级、饮酒史、吸烟史、慢性病史、过敏史。以是否选择手术治疗为变量，使用单因素logistic分析影响因素及分别与选择治疗、是否手术的关系。结果 患者一般情况：其中单因素分析中有4个影响因素与治疗决策相关，“脉搏”（P0.01）、“受伤机制”（P0.01）、“腹部CT”（P0.01）、“脾损伤分级”（P0.01），有统计学意义。其余影响因素无统计学意义。特别是年龄因素。45例患者入院结合患者入院脉搏、受伤机制、腹部CT及脾破裂评分选择行7例非手术治疗，选择行26例直接行介入治疗，选择行10例行手术治疗，治疗后1w复查腹部CT，有1例栓塞后出现脾脏液化后期介入引流，有1例栓塞后仍再血，再次手术切除脾脏。均无无严重并发症发生。结论 对于脾脏破裂患者的受伤后脉搏、受伤机制、腹部CT、脾脏损伤分级对患者的诊治及预后有重要意义，能更有效、经济、方便、准确评估患者手术治疗的选择。减少脾破裂的诊断失误及选择治疗方式的选择。 　　关键词：腹部闭合伤；脾破裂；腹部CT ；脾破裂评分 　　Abstract：Objective Through review of the clinical data of adult traumatic spleen rupture， the value of abdominal CT combined with spleen rupture scores in diagnosis， treatment and prognosis of patients with abdominal closed injury of spleen rupture was explored in order to guide the clinical medical work give an accurate and effective decision making on the treatment of patients with traumatic spleen rupture.Methods Through a retrospective analysis and observation and collecting patients with abdominal closed injury of spleen rupture in emergency surgery of medical college affiliated hospital from February 2012 to February 2015，the bring into and exclusion criteria were developed and 45 cases were collected.A total of 16 factors were collected， such as gender， age， injured site condition， cause of injury， admission temperature， admission pulse， admission blood pressure， abdominal united injury， external combined injury， abdominal computed tomography （CT）， spleen rupture classification， history of drinking， smoking， chronic medical and allergies and whether operation.Taking whether operationas variable， the influencing factors and their relations with whether operation was respectively analyzed. Results General conditions of patients： in single factor analysis， four related factors of them were associated with treatm