经导管动脉栓塞术治疗骨盆骨折大出血的病例对照研究

Case control study on transcatheter artery embolization for massive bleeding due to pelvic fractures

目的:探讨经导管动脉栓塞术治疗骨盆骨折并发大出血中的技术特点与临床疗效。方法:回顾性分析了自1998年3月至2008年2月92例骨盆骨折大出血患者的临床资料。保守组53例,其中男43例,女10例;年龄27～61岁,平均(37.2±5.7)岁;以大量输血、补液为主。栓塞组39例,男26例,女13例;年龄26～62岁,平均(35.3±9.5)岁;在上述基础治疗上加行经导管动脉栓塞术。对两组患者的输血量、输液量、休克纠正时间和存活率进行比较,并记录栓塞组患者止血有效率和术中术后并发症。结果:栓塞组患者在术后2h内出血得到控制,33例均一次性止血成功,术中无医源性神经、血管、脏器等损伤,术后3例发生下肢麻木,5例发生臀部红肿。栓塞组在输血量、输液量、休克纠正时间和存活率等指标上均优于保守组。结论:经导管动脉栓塞术是骨盆骨折大出血的一种早期、迅速、有效的急救止血手段。

Objective：To investigate the techniques and curative effects of transcatheter artery embolization （TAE） for massive bleeding due to pelvic fractures.Methods：The clinical data of 92 patients with haemorrhage due to pelvic fractures from March 1998 to February 2008 were retrospectively analyzed.Among 53 patients treated conservatively such as massive transfusion and fluid infusion in the control group,43 patients were male and 10 patients were female,ranging in age from 27 to 61 years,averaged （37.2±5.7）years.Among 39 patients who were hemodynamically unstable or had evidences of ongoing hemorrhage required TAE,26 patients were male and 13 patients were female,ranging in age from 26 to 62 years, with a mean age of （35.3±9.5） years.The clinical date such as blood or fluid transfusion volume,shock redress time and survival rate were compared between the two groups.The hemostatic efficiency and complications of the surgery were also analyzed.Results：The average hemostasis time of TAE group was 2 hours.There were no intraoperative injuries of blood vessels,nerve or vital organs.Three patients had lower limbs numbness and 5 patients had gluteal skin redness after the operation.The blood transfusion or fluid infusion volume,shock redress time and survival rate were all significantly better than those in the conservative group.Conclusions：TAE is an early,rapid and effective method in controlling haemorrhage due to pelvic fractures.