外伤性脾破裂失血性休克的相关因素分析及临床诊治对策

The related factors and its clinical treatment measures of hemorrhagic shock in traumatic spleen rupture

目的探讨影响外伤性脾破裂失血性休克的相关因素，并予以相对应的措施进行治疗。方法回顾性分析2008年1月～2013年1月72例外伤性脾破裂患者的临床资料，对其中36例失血性休克患者进行影像因素分析，并予以对症治疗，观察治疗后的效果。结果36例患者中35例抢救成功，成功率97．2％。平均手术时间（134．6±54．2）min，平均住院时间（19．6±5．8）d；影响外伤性脾破裂失血性休克的因素有高龄（〉60岁），多种复合伤（〉2种），格拉斯评分低（≤8分），动脉收缩压波动大（〉30mmHg），有脏器功能衰竭综合征，出血量大（〉1500mL），低血压持续时间长（〉2h），重度贫血；其中出血量大、多种复合伤、高龄是高危险因素（P〈0．05）。结论高度关注外伤性脾破裂失血性休克的危险因素，早期对症治疗有助于提高临床效果，降低死亡发生率。

Objective To observe the factors relating to traumatic spleen rupture hemorrhagic shock and propose the corresponding treatment measures. Methods The clinical data of 72 cases with traumatic spleen rupture from January 2008 to January 2013 were analyzed retrospectively. 36 patients with hemorrhagic shock received image factor analysis and the corresponding treatment. The effect after treatment was observed. Results For 36 cases, there were 35 patients with successful rescue, and the successful rate was 97.2%. The average operation time was （134.6±54.2）rain and the average length of stay was （19.6±5.8）d. The factors influencing traumatic spleen rupture hemorrhagic shock included advanced age（〉 60 years old）, a variety of compound injury （ 〉 2 kinds）, low Glass marking （≤8 scores）, large artery systolic blood pressure fluctuations （〉30ram Hg）, viscera function failure syndrome, large bleeding volume （〉 1500mL）, long duration of hypotension （〉2h） and severe anemia, in which large bleeding volume, a variety of com- pound injury and advanced age were high-risk factors. Conclusion Closely observing risk factors relating to traumatic spleen rupture hemorrhagic shock and taking symptomatic treatment in the early treatment can improve the clinical ef- fect and reduce the death rate.