介入栓塞治疗急性动脉出血55例效果分析

Effect of endovascular embolization on acute arterial hemorrhage in 55 patients

目的探讨急性动脉出血患者行介入栓塞治疗的止血效果。方法急性动脉出血患者87例,行数字减影血管造影(digital subtraction angiography,DSA)检查后分为DSA阳性组55例,DSA阴性组32例。DSA阳性组给予介入栓塞治疗,DSA阴性组给予输血、补液、纠正凝血功能异常、局部应用止血药物等常规治疗。比较2组一般资料,入ICU时急性生理和慢性健康评分Ⅱ(Acute Physiology and Chronic Health EvaluationⅡ,APACHEⅡ)、ICU治疗时间、ICU病死率、住院28d病死率、住院期间复发率及并发症发生情况。结果 2组年龄、性别比例、入ICU时APACHEⅡ评分比较差异均无统计学意义(P>0.05);DSA阳性组止血有效率(87.3%)较DSA阴性组(53.1%)高,ICU治疗时间[(5.67±2.41)d]较DSA阴性组[(7.53±3.32)d]短,28d病死率(3.6%)、住院期间复发率(12.7%)较DSA阴性组(18.8%、43.8%)低(P<0.05);DSA阳性组ICU病死率(3.8%)与DSA阴性组(12.5%)比较差异无统计学意义(P>0.05);DSA术中及术后48h内,2组均未发生严重并发症。结论急性动脉出血患者早期行DSA检查及时发现出血部位并针对性栓塞治疗,可有效止血、缩短住院时间和降低28d病死率。

Objective To observe the effect of endovascular embolization on acute arterial hemorrhage.Methods Eightyseven patients with acute arterial hemorrhage underwent digital subtration angiography（DSA）and were divided into DSA positive group（n=55）receiving endovascular embolization and DSA negative group（n=32）receiving conventional therapy as blood transfusion,fluid infusion,correction of coagulation function and local utilization of hemostatics.The general data,Acute Physiology and Chronic Health Evaluation Ⅱ（APACHEⅡ）at admission to ICU,ICU stay,ICU fatality,28-day fatality,relapse rate and complications in hospital were compared between two groups.Results There were no significant differences in the age,sex ratio and APACHE Ⅱ between two groups（P〈0.05）.The effective rate of hemostasis was significantly higher in DSA positive group（87.3%）than that in DSA negative group（53.1%）（P〈0.05）.The ICU stay was significantly shorter in DSA positive group（（5.67±2.41）d）than that in DSA negative group（（7.53±3.32）d）（P〈0.05）.And the 28-day fatality and relapse rate were significantly lower in DSA positive group（3.6%,12.7%）than those in DSA negative group（18.8%,43.8%）（P〈0.05）.There was no significant difference in ICU fatality between DSA positive and negative groups（3.8%vs 12.5%）（P〈0.05）.No severe complications occurred during DSA and in 48 hafter DSA in two groups.Conclusion The early DSA in acute arterial hemorrhage patients can detect hemorrhage site in time and perform target embolization so as to stop hemorrhage effectively,shorten the hospitalization stay and reduce the 28-day fatality.