闭合性肝损伤手术治疗危险因素102例分析

Risk factors for operative management with blunt liver injury:A report of 102 cases

目的探讨闭合性肝损伤手术治疗的危险因素。方法回顾性分析2003-10-01至2016-05-01南京军区福州总医院收治的102例闭合性肝损伤病人临床资料,通过腹部CT检查或手术中探查确定肝损伤的程度分级。按是否手术治疗,并根据影像学Becker分级及美国创伤外科学会-器官损伤分级(AAST-OIS),分为手术组51例,非手术组51例,肝损伤分级包括Ⅰ级23例、Ⅱ级33例、Ⅲ级24例、Ⅳ级18例、Ⅴ级4例。采用单因素分析和多因素Logistic回归法分析肝损伤手术治疗的相关因素,确定肝损伤手术治疗的独立危险因素。通过受试者工作特征曲线(ROC曲线)确定肝损伤治疗独立危险因素的阈值。结果单因素分析显示,闭合性肝损伤手术治疗的相关因素有丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、血红蛋白(Hb)、血细胞比容(HCT)、血清钾(K^+)、心率(HR)、收缩期血压(SBP)、美国创伤外科学会-器官损伤分级、腹膜刺激征、合并腹腔其他器官损伤。Pearson积差相关系数分析提示血清K^+和血清钠(Na^+)的水平在两组中呈负相关,SBP和HR的水平在两组中呈负相关,ALT和AST的水平在两组中呈正相关,肝损伤程度分级和腹膜刺激征在两组中呈正相关。通过ROC曲线评估得出ALT、血清K^+、SBP的手术治疗最佳阈值分别为171.5 U/L、3.625 mmol/L、96.5 mmHg(1 mmHg=0.133k Pa)。多因素Logistic回归分析发现SBP<96.5 mmHg、血清K^+<3.625 mmol/L、合并腹腔其他器官损伤、腹膜刺激征是闭合性肝损伤手术治疗的独立危险因素。结论 SBP<96.5 mmHg、血清K^+<3.625mmol/L、合并腹腔其他器官损伤、腹膜刺激征为闭合性肝损伤手术治疗的高危因素。

Objective To investigate the risk factors for operative management with blunt liver injury. Methods One hundred and two cases of blunt liver injury admitted in the Fuzhou General Hospital of Nanjing Military Command between October 1,2003 and May 1,2016 were reviewed retrospectively. The grading of the liver injury was verified by using surgical operation or CT scans. According to whether were operative management, and depending on the American Association for the Surgery of Trauma-organ injury scale （AAST-OIS） and imaging Becker rating, all the cases were divided into operative management group and non-operative management group, including 23 cases of grade Ⅰ , 33 cases of grade Ⅱ, 24 cases of grade Ⅲ , 18 cases of grade Ⅳ, and 4 cases of grade Ⅴ. Univariate and multivariate Logistic analysis were performed to investigate correlative factors of operative management with blunt liver injury to identify independent risk factors of operative management with blunt liver injury. Using receiver operating characteristic curse, it determined the threshold of independent risk factors of operative management with blunt liver injury. Results Univariate analysis showed that correlative factors of operative management with blunt liver injury include alanine aminotransferase, aspartate aminotransferase, hemodobin, hematocrit,serum potassium, heart rate, systolic bloodpressure, the American Society for Surgery of Trauma-organ injury scale, peritoneal irritation, merger intraperitoneal other organ damage. Pearson product-moment correlation coefficient analysis showed that levels of serum potassium and sodium were correlated negatively, levels of blood pressure and heart rate were correlated negatively, levels of alanine aminotransferase and aspartate aminotransferase were correlated positively, and the liver grading and peritoneal irritation were correlated positively in both groups. Alanine aminotransferase, serum potassium and systolic blood pressure of the best threshold of operative management with blunt liver injury were 171.5 U/L, 3.625 mmol/L, 96.5 mmHg （1 mmHg= 0.133 kPa）respectively by the ROC curve. Logistic multivariate regression analysis showed that blood pressure 〈 96.5mmHg, serum potassium 〈3.625 mmol/L, merger intraperitoneal other organ damage and peritoneal irritation were independent risk factors for operative management with blunt liver injury. Conclusion Blood pressure 〈96.5 mmHg, serum potassium 〈3.625 mmol/L, merger intraperitoneal other organ damage and peritoneal irritation were the high risk factors of operative management with blunt liver injury.