影响闭合性肝外伤患者处理方法的因素

Influence factors of treatment ways to patients with closed hepatic trauma

目的:研究对闭合性肝外伤患者处理的影响因素,以选择合适的治疗措施。方法:回顾性分析我院2006年5月至2012年5月收治的86例成人单纯闭合性肝外伤患者临床资料,并按处理方法的不同分为手术(O)组(n=50)与非手术(NO)组(n=36),以中心静脉压(CVP)、心率(HR)、平均动脉压(MAP)、血红蛋白(Hb)及腹腔积液量为观察指标,对两组患者进行统计学分析与对比。结果:NO组入院时CVP、HR、MAP、HB及腹腔积液量与O组比较,均具有显著差异(P<0.01)。肝外伤分级治疗Ⅰ级非手术成功率为100%;Ⅱ级非手术成功率为83.3%;Ⅲ级非手术成功率为66.7%;Ⅱ、Ⅲ、Ⅳ级手术成功率为100%;Ⅴ级手术成功率为60%。结论:闭合性肝外伤处理方法的选择主要依赖于对血流动力学、腹腔积液量的密切观察,尤其是CVP的监测,结合CT损伤分级,避免不必要的外科手术。

Objective To study the influence factors of treatment ways to the patients with closed hepatic trauma, and to select the appropriate treatment strategy. Methods The clinical data of 86 patients with closed hepatic trauma admitted in our hospital from May, 2006 to May, 2012 were retrospectively analyzed, divided into the operation （O） group （n = 50） and non-operation （NO） group （n = 36）. Central venous pressure （CVP）, heart rate （HR）, mean arterial pressure （MAP）, hemoglobin （HB） and the abdominal fluid volume were observed, statistically analyzed and compared between two groups. Results There were significant difference between NO group and O group in CVP, HR, MAP, HB and abdominal fluid volume （P 〈 0.01）. The success rate of classified treatment of hepatic trauma： grade I was 100%, grade II was 83.3% and grade III was 66.7% in NO group; grade Ⅱ , Ⅲ ,Ⅳ were 100%, grade V was 60% in O group. Conclusions The choice of treatment ways to the patients with closed hepatic trauma mainly depended on the close observation of haemodynamics, abdominal fluid volume, especially CVP, combination with CT injury grading, unnecessary operations were avoided.