创伤性脾破裂出血超声造影介入止血治疗后临床观察

Clinical observation of contrast-enhanced ultrasound interventional hemostasis for traumatic spleen rupture bleeding

目的:总结创伤后脾破裂Ⅲ-Ⅳ级行超声造影(contrast-enhanced ultrasound,CEUS)(引导下止血剂局部介入微创治疗的急诊患者的临床特点,从而更好地实施积极有效的治疗促进患者康复。方法:分析自2007-06-2011-06在我科治疗的87例创伤后脾破裂Ⅲ-Ⅳ级行CEUS介入止血治疗的急诊患者,动态监测患者血流动力学及治疗后6h、1d、2d、3d、7d的超声造影、生命体征及相关指标,观察腹腔是否有活动性再出血。结果:87例行超声介入止血的患者治疗后即刻CEUS显示无活动性出血,与治疗前相比,治疗后6h^7d血压、心率、血小板及呼吸频率差异均无统计学意义(P>0.05),而血红蛋白、腹腔积液、中心静脉压较治疗前差异有统计学意义(P<0.05)。结论:CEUS引导下对脾破裂出血进行局部止血剂注射治疗能有效控制腹腔出血,大大提高了患者保器官治疗的成功,对患者早日康复,减少住院时间和费用有积极的临床价值。

Objective：To summarize the clinical characteristics of traumatic spleen bleeding treated by hemo- static agent locally applied under the guidance of contrast-enhanced ultrasound （CEUS）. Method.. From June 2007 to June 2011 ,eighty-seven patients of traumatic spleen bleeding （ HI - IV grade） were treated by CEUS guided in- terventional hemostasis. The patients＇ hemodynamics, CEUS and associated iindicators were dynamic monitored 6 hours, one day, 2 days, 3 days, 7 days after treatment. Result： There was no active bleeding diagnosed by immediate- ly CEUS after local hemostasis in all eighty-seven cases. There was no statistical difference in blood pressure, heart rate,platelets,and respiratory rate （P〉0. 05） compared with pre therapy after treatment, but significant statisti- cally differences were found in hemoglobin, ascites, and central venous pressure （P〈0. 05）. Conclusion： CEUS- guided local injection of haemostatic agent can effectively control abdominal hemorrhage in treating traumatic spleen bleeding. The treatment greatly improve the success rate of the insurance organs and have great value in promoting the early recovery,reducing the length of hospital stay and costs.