血管介入治疗血流动力学不稳定型骨盆骨折12例疗效分析

Curative Effect Analysis of 12 Hemodynamically Unstable Pelvic Fracture Patients Treated with Angiographic Embolization

目的探讨血管介入治疗血流动力学不稳定型骨盆骨折的临床价值。方法对12例血流动力学不稳定型骨盆骨折患者的临床资料进行分析。实施血管造影后,根据是否有造影剂外溢判断有无动脉损伤。对损伤血管进行选择性栓塞;对无明显造影剂外溢但动脉分支呈现充盈缺损者,行非选择性动脉血管栓塞。对栓塞前和栓塞后4 h血流动力学指标进行比较。结果本组12例患者中,8例造影显示髂内动脉及其分支损伤,立即对出血动脉进行明胶海绵颗粒栓塞治疗,栓塞后再次进行血管造影,观察有无遗漏的破裂血管及栓塞后的血管内明胶海绵脱落;另外4例无明显造影剂外溢,行非选择性动脉血管栓塞。全部12例患者休克症状在栓塞治疗后均得到有效控制,心率从(143.26±11.62)次/min下降至(100.75±9.57)次/min,收缩压从(82.41±7.26)mm Hg上升至(100.66±8.83)mm Hg,中心静脉压从(3.13±0.12)mm Hg上升至(3.59±0.15)mm Hg,血乳酸盐从(13.85±1.36)mmol/L下降至(6.22±1.01)mmol/L。经Mauchly"球对称"检验后,采用重复测量数据进行方差分析,差异有统计学意义(P<0.01)。结论血管介入治疗是抢救血流动力学不稳定型骨盆骨折的有效治疗方式,具有快捷、创伤小、安全有效的优点。

University; Objective To investigate the clinical value of angiography and embolization in treating patients with hemodynamically unstable pelvic fractures,a troublesome problem for surgeons. Methods An analysis was made on hemodynamic parameters of 12 hemodynamically unstable pelvic fractures underwent digital subtraction angiography（ DSA） and angiographic embolization at preoperation and postoperation. Results All 8 cases were performed the selective artery embolization under DSA with contrast media exosmosis,4 cases were performed no selectively angiographic embolization with no obvious contrast media exosmosis. After angiographic embolization,those clinical indexes including heart rate,blood pressure,central venous pressure（ CVP） and blood lactic acid were better significantly than those before treatment by Mauchly sphericity test（ P〈0. 01）. The heart rate decreased from（ 143. 26 ± 11. 62） beat / min to（ 100. 75 ± 9. 57） beat / min; systolic pressure increased from（ 82. 41 ± 7. 26） mm Hg to（ 100. 66 ± 8. 83） mm Hg; CVP increased from（ 3. 13 ± 0. 12） mm Hg to（ 3. 59 ± 0. 15） mm Hg. Conclusion Angiographic embolization is an effective approach for the treatment of hemodynamically unstable pelvic fracture.