超声造影介入止血治疗创伤性肝脾破裂出血急救护理的探讨

Contrast enhanced ultrasound interventional treatment of traumatic spleen rupture hemorrhage homeostasis in emergency nursing care

目的 探讨142例肝脾破裂患者进行超声造影（CEUS）引导下介入止血治疗的护理方法和建立规范化的护理流程.方法 对55例肝破裂,87例脾破裂患者进行超声造影引导下的介入止血治疗.依据美国创伤外科协会的分级（AAST）[1]标准,对创伤引起的肝脾破裂Ⅲ-Ⅳ级患者进行超声造影引导下的止血治疗.动态监测患者生命体征,介入止血治疗后1天、2天、3天、7天的腹膜刺激症状、腹腔积液及血液血红蛋白（HB）数值进行动态观察,及早发现腹腔是否存在活动性再出血.结果 138例CEUS患者引导注射后即刻显示无活动性出血,治疗1h后的血压稍升高,但与治疗前相比,无统计学差异（P＞0.05）,心率及呼吸频率治疗前后虽有变化,但均无统计学差异（P＞0.05）.治疗前后HB（97.72±11.29）,腹腔积液（8.14±3.09）,剔除其它合并伤因素,患者平均住院日（6.96±2.17）d.结论 CEUS引导下局部止血剂注射治疗肝脾破裂出血,止血效果可靠、操作安全简便,护理人员采取有效的、规范化的护理措施是保障治疗成功的关键.

Objective To investigate 142 cases of rupture of liver and spleen in patients with contrast-enhanced ultrasound （contrast enhanced ultrasound, CEUS）- guided with interventional hemostatic therapy nursing methods and the establishment of a standardized nursing process. Methods 55 cases of rupture of liver and 87 cases of rupture of spleen were treated with contrast enhanced ultrasound guided interventional hemostatic therapy. Guided by the provision 1 in the American association for the surgery of trauma grading （Injury Scale of the American Association for the Surgery of Trauma, AAST）, the trauma caused by rupture of spleen III- IV was treated with contrast enhanced uhrasound guided hemostatic therapy. Dynamic monitoring was performed on the vital signs, symptoms of peritoneal irritation, peritoneal effusion and blood hemoglobin （HB） numerical dynamic observation after the intervention of hemostasis therapy in 1 day, 2 days, 3 days, and 7 days, in order to detect any possible peritoneal bleeding. Results 138 patients received CEUS guided injection reflected no immediate active bleeding, their blood pressure slightly elevated one hour after the treatment yet no statistical difference （P〉 0.05） comparing with that prior to the treatment. Neither heart beat rate nor respiration rate demonstrated any statistical difference in between. Before and after the treatment, it reflected HB （97.72±11.29）, peritoneal effusion （8.14±3.09） regardless other factors, the average hospitalization was 6.96±2.17 days. Conclusion CEUS guided topical hemostatic agent injection in treatment of spleen rupture and hemorrhage is considered being reliable, simple and safe. A set of standard and effective nursing measures is the key to guarantee a successful treatment.