三种止血方法治疗骨盆骨折大出血的临床效果比较

Clinical comparison of three hemostatic methods for controlling pelvic fracture hemorrhoea

目的比较纱布填塞术、髂内动脉结扎术和动脉导管栓塞术在骨盆骨折大出血急救时的止血效果。方法回顾性分析23例骨盆骨折合并大出血患者的临床资料，其中8例应用纱布填塞术（填塞组），6例应用髂内动脉结扎术（结扎组），9例应用动脉导管栓塞术（栓塞组）。比较三组患者的创伤严重程度评分（ISS）、术前休克指数、术中控制休克的时间、术后输血量、术后ICU住院天数、并发症等。结果填塞组术中控制休克时间、术后输血量和术后ICU住院天数分别为（70．00±24．50）min、（1050．00±207．02）mL和（10．124-1．64）d，结扎组分别为（40．83±12．01）min、（1800．00．4-400．00）mL和（11．17±1．72）d，栓塞组分别为（91．67±22．64）rain、（1644．44±421．64）mL和（7．22±1．56）d，三组差异均有统计学意义（F=10．323、9．265、12．235，均P〈0．05），并且结扎组术中控制休克时间最短；填塞组术后输血量最少；栓塞组术后ICU住院天数最短。填塞组4例感染，感染率50％，其中1例于术后第8天死亡；结扎组1例合并颅脑和腹腔脏器损伤，于术后第11天死于多器官功能衰竭。结论纱布填塞术操作难度小，止血效果明确，适合于开放性骨折患者和基层医院对骨盆骨折的急救；髂内动脉结扎术操作快，能及时控制休克；动脉导管栓塞术对患者创伤小，止血效能明确，但专业性强，操作难度大。临床医生应灵活并综合利用各止血方法。

Objective To compare the efficiency of gauze packing, internal iliac artery ligation and tran- scatheter arterial embolization for controlling pelvic fracture hemorrhoea. Methods The clinical data of 23 consecu- tive patients with pelvic fracture hemorrhoea were retrospectively analyzed. There were 8 patients who had undergone gauze packing,6 patients undergone artery ligation,9 patients undergone angioembolization. The ISS,the preoperative shock index, the operation time of control the shock,the postoperative blood transfusion, the days in ICU after opera- tion and the complication were all recorded respectively. Results The operation time of control the shock, the postop- erative blood transfusion and the days in ICU after operation of the packing group were （70.00 ±24. 50） min, （1 050.00 ±207.02） mL and （ 10. 12 ± 1.64） d; the ligation group were （40.83 ± 12. 01 ） min, （ 1 800.00 ±400.00 ） mL and （ 11.17 ± 1.72 ） d ; the angioembolization group were （ 91.67± 22.64 ） min, （ 1 644.44 ± 421.64 ） mL and （7.22 ± 1.56） d. The difference between the three groups had statistical significance with the indexes above all（ F = 10.323,9. 265,12. 235, all P 〈 0.05 ）, and the ligation group had the shortest operation time to control the shock,the packing group had the least postoperative blood transfusion, the angioembolization group had the shortest days in ICU after operation. There were 4 cases in the packing group suffering the infection, the infection rates as high as 50% ,one of them died on the 8d; there were one case in the ]igation group died of MODS on the llth day. Conclusion The gauze packing is a sample and effective hemostasis, suitable for the patients with open fracture and the fist aid for pelvic fracture in the basic level hospitals; the internal iliac artery ligation can control the shock timely but the hemostatic efficacy is not better than the other two kinds of operation; the transcatheter arterial embolization has micro injury and effective hemostatic efficacy, however, the strong profession and the lage difficulty may delay the patients＇condition. So the doctors should use the methods of hemostasis flexiblely and comprehensively.