术中主干静脉意外损伤的出血控制和治疗

The Bleeding Control and Treatment of Major Venous Injuries Accidentally Incurred During Operation

目的探讨术中主干静脉意外损伤（MVIhI）的出血控制和治疗方法。方at回顾性分析我科2005年11月至2011年12月MVIA113例患者的临床资料。出血控制采用非器械法即指压、手捏、纱布棉垫压迫和血管器械法，治疗采用非修复方法即结扎、缝扎法和修复方法即吻合、修补法。总结损伤静脉分布、出血特点，分析不同出血控制和治疗方法的应用频率及结局事件。结果MVIAI含8种共13条主干静脉；出血量、输血量分别为200-4500ml、400-4300ml，极差R分别为4300ml、3900ml，偏度分别为2．323、2．154；指压、手捏、纱布棉垫压迫和血管器械法的应用频率分别为47．06％、11．76％、23．53％、17．65％，结扎、缝扎、吻合、修补法的应用频率分别为15．38％、7．69％、7．69％、69．23％；非器械、器械法出血控制的出血量均数分别为890ml、1533．3ml，差值MD=643．3ml（95％CI：-2498．61211．9X修复组、非修复组的累计不良事件发生率分别为20％、0％，非修复组的绝对危险降低率ARR=20％（95％CI：-0．0480．448），NNT=5。结论MVIAI累及静脉多样，出血量个体差异大、分布正偏，非器械出血控制和非修复治疗方法可改善临床结局、降低危险度。

Objective To explore the bleeding control and treatment methods of major venous injuries accidentally incurred（MVIAI） during operation. Methods The clinical data of 13 MVIAI cases from November 2005 to December 2011 were retrospectively analyzed, vascular instruments and finger compression, hand holding, gauze or pad compression were used for bleeding control, ligation, suture ligation, anastomosis and repair were used for treatment, MVIAI types, bleeding volume, the frequency of bleeding control and treatment methods and its ending events were analyzed. Results MVIAI consisted of 8 venous types including 13 major veins, bleeding and transfusion volumes were 200＂4500ml, 400＂4300ml respectively, range were 890ml, 1533.3ml, kurtosis were 2.323, 2.154, the using frequency of finger compression, hand holding, gauze or pad compression, vascular instruments were 47.06%, of ligation, suture ligation, anastomosis and repair 11.76%, 23.53%, 17.65% respectively, the frequency were 15.38%. 7.69%, 7.69%, 69.23% respectivelybleeding mean difference between instrument and non-instrunlent groups was 643.3n11（95%CI： -2498.6-1211. 9）, accumulative incidence of complications between two groups were 20%. 0%, absolute risk reduction（ARR） of non-repair group was 20%（95%CI： -0.048-0.448）, number needed to treat（NNT）=5. Conclusion MVIAI involves different veins, individual differences of blood loss is contrasting, non-instrument bleeding control and non-repair treatnlent can improve clinical outconles and decrease risks.