肝损伤临床分级及治疗方法的探讨.docVIP

肝损伤临床分级及治疗方法的探讨 陈中伟 马晓 陈伟 黄存 「摘要」 目的：探讨肝损伤临床分级及两种治疗方法的比较。方法：将我院近5年收治的闭合性肝损伤患者按治疗方法分为手术组86例及非手术组110例。对比两组患者住院天数、年龄等一般指标，同时监测两组患者入院时、治疗第3天、治疗第7天及出院时血色素(HGB)、白细胞(WBC)、血小板(PLT)、直接胆红素(DBIL)、间接胆红素(IBIL)、天门冬氨酸转移酶(AST)、丙氨酸氨基转移酶(ALT)的动态变化。结果：两组患者年龄比较无明显差异(p﹥0.05)，住院天数非手术组较手术组缩短(p﹤0.05)。各项指标上：DBIL、HGB两组比较在四个时间段均有统计学意义(p﹤0.05)；WBC、AST在治疗第7天和出院时两组比较有统计学意义(p﹤0.05)；PLT、IBIL、ALT两组比较在四个时间段均无明显差异(p﹥0.05)。结论：正确把握治疗原则，把握手术适应症。在血流动力学稳定及严密监测情况下，尽可能选择非手术治疗。 「关键词」 肝损伤；分级；非手术治疗 Objective:To discuss clinic grading and contrast of two kinds of treatment about the hepatic trauma；Methods: Choose patients with closed hepatic trauma were hospitalized in our hospital in past five years,which were divided into operative group of 86 cases and nonoperative group of 110 cases according to treatment. To compare the days in hospital and the age et,Before the treatment and 3th,7th day after the treatment and the time live hospital,HGB,WBC,PLT,IBIL,DBIL,AST,ALT in two groups were recorded and analyzed ；Results: There have no obvious difference in two groups about age(p﹥0.05),the nonoperative group was shorter than the operative group about days in hospital(p﹤0.05). there have difference in two groups of HGB and DBIL in the four time(p﹤0.05). there have difference in two groups of WBC and AST in 7th day after the treatment and the time live hospital(p﹤0.05). there have no difference in two groups of PLT、IBIL、ALT in the four time(p﹥0.05)；Conclusion:We must grasp the treatment principle and the operation indication exactly.we should choose the nonoperative treatment try our best if with stable hemodynamics and rigorous monitor. [Key words]：Hepatic trauma；Grading；Nonoperative treatment 肝脏是人体中最大的实质性脏器，血管丰富，质脆易碎。肝损伤可分为开放性肝损伤和闭合性肝损伤。开放性肝损伤需尽早剖腹手术探查，而针对闭合性肝损伤的处理，近些年来随着临床经验的广泛积累，治疗的观念发生了重大变化，非手术治疗已逐渐占据了主导性的地位[1]。笔者总结我院各相关科室近5年收治的闭合性肝损伤患者，并对其分级及治疗做一探讨。 1 资料与方法 1.1 临床资料 选择2006-2011年我院各相关科室收治的有闭合性肝损伤的患者196例，分为手术组（A组）86例及非手术组（B组）110例。两组患者一般资料见表1。其中肝胆外科78例，普胸外科29例，神经外科26例，骨科28例，急诊ICU35例。受伤机制中：A组：车祸伤