外份性脾破裂患者治疗策略的影响因素分析

Traumatic splenic rupture, conservative vs surgical therapy

目的探讨外伤性脾破裂患者临床治疗策略的影响因素。方法回顾性分析2008年4月至2016年6月解放军第四二二医院收治的124例外伤性脾破裂患者的临床资料，其中保守治疗38例，手术治疗86例。比较两组患者临床特征、CT影像资料，探讨影响外伤性脾破裂临床治疗策略的相关因素。结果单因素分析结果显示受伤原因、入院血压、脉搏、CT分级及腹腔穿刺情况与治疗方案选择密切相关。多因素Logistic回归分析结果显示脉搏（OR=4．264，95％CI1．206～15．073）、CT分级（OR=2．086．95％C11．019～4．271）和腹腔穿刺情况（OR=3．428，95％CI1．024～11．479）是外伤性脾破裂治疗策略选择的重要决定性因素。86例手术治疗患者占总患者的69．4％，其中cT分级1。2级的患者手术率为58．1％，CT分级3—4级的患者手术率为94．7％。结论外伤性脾破裂的治疗以手术治疗为主，对于血流动力学稳定以及CT分级1～2级的患者可谨慎采取保守治疗。

Objective To evaluate management stratagy for patients with traumatic splenic rupture. Methods The clinical data of 124 patients with traumatic splenic rupture admitted to the 422 Hospital of PLA from April 2008 to June 2016 were retrospectively analyzed. 38 patients were treated conservatively, while 86 patients underwent surgery. To investigate impact factors of management strategy in patients with traumatic splenic rupture, clinical characteristics and CT features between the two groups were compared. Results Univariate analysis results showed that injury causes, blood pressure, at admission, pulse, CT grade and abdominocentesis were closely related with therapeutic scheme. And multivariate Logistic regression analysis results showed that pulse （OR = 4. 264,95% CI 1. 206 -15. 073）, CT grade （OR = 2. 086,95% CI 1. 019 - 4. 271 ） and abdominocentesis （ OR = 3.428,95% C[ 1. 024 - 11. 479） were the significant determining factors of therapeutic scheme in patients with traumatic splenic rupture. Surgical intervention was carried out in 86 patients accounting for 69.4% of all patients. The rate of surgical intervention was 58.1% in the patients with CT grade of 1 and 2, that was 94.7% in patients with CT grade of 3 and 4. Conclusions Operative management is needed for most traumatic splenic rupture, patients those with hemodynamic stability and CT grade of 1 or 2 may be qualified for watchful non-operative management.