外伤性脾破裂的非手术治疗失败病例分析

THE ANALYSIS OF THE FAILURE REASONS OF NON-OPERATIVE TREATMENT TO THE PATIENT OF TRAUMATIC SPLEEN RUPTURE

目的分析外伤性脾破裂病人非手术治疗失败的原因,从而严格掌握非手术治疗的适应证,为今后对临床外伤性脾破裂病人的救治提供更多的经验。方法收集我院2007年1月～2010年12月间住院治疗的11例非手术治疗失败的外伤性脾破裂病人的资料,通过归纳病人腹部体征的变化、生命体征的变化、影像学检查资料以及脾损伤的分级来分析其保守治疗失败的原因。结果非手术治疗失败的原因有:6例因为出现腹膜炎体征加重,血色素下降;11例生命体征不平稳;5例CT观察血肿增大;3例由于脾损伤分级有误。结论在外伤性脾破裂病人采用保守治疗的过程中,不但要严格掌握保守治疗的适应症,更应密切观察病人的腹部体征和生命体征以及影像学随访检查结果,这是保障非手术治疗病人安全的重要措施。

Objective To analyse the failure reasons of non-operative treatment to the patient of traumatic spleen rupture,thus strictly mastering the indications of non-operative therapy for future,to provide more experience to clinical treatment of traumatic spleen rupture.Methods This paper collected 11 non-operative cases of failure treatment to traumatic spleen rupture in The Third People＇s hospital of Hefei City from January 2007 to December 2010.By generalizing the change of patient＇s belly signs,the change of vital signs,checking the image data and classifing the spleenic damage,we can analyse the reasons for the failure of conservative treatment.Results Reasons for the non-operative treatment failure are in the following： 6 cases of them is due to appearing aggravation of peritonitis signs and hemoglobin declining,9 cases vital signs are not stable,hematoma in 5 cases increase greatly in CT observation,the rest 3 cases is due to incorrect classification of spleenic injuries.Conclusions While giving patients of traumatic spleen rupture conservative treatment,doctors should not only strictly handle the indications of conservative treatment,but also observe the patient＇s belly signs,vital signs and radiological follow-up examination results closely,which are the important measures to safeguard non-operative patients.