急诊介入栓塞治疗骨盆骨折小动脉损伤隐匿性出血

Emergent interventional embolization for concealed hemorrhage of small artery injury in patients with pelvic fracture

目的探讨急诊介入栓塞治疗骨盆骨折小动脉损伤隐匿性出血的临床价值。方法回顾性分析14例骨盆骨折小动脉损伤隐匿性出血患者的资料。14例均接受急诊介入栓塞止血,栓塞材料为明胶海绵颗粒、微弹簧圈。结果 14例动脉期造影均未见明显对比剂染色或积聚,延迟期共发现34条小动脉中远端表现为少量对比剂轻度染色或积聚,超选择性插管造影可见明显对比剂外溢。对34条出血小动脉均成功栓塞止血。术后2例患者因失血性休克、严重酸中毒及多脏器衰竭死亡。结论对骨盆骨折小动脉损伤隐匿性出血患者,超选择性介入栓塞是有效止血措施,延迟期造影有利于提高对小动脉损伤的检出率。

Objective To explore the clinical value of emergent interventional embolization in treatment of concealed hemorrhage of small artery injury in patients with pelvic fracture.Methods Clinical data of 14 patients with concealed hemorrhage of small artery injury caused by pelvic fracture were retrospectively analyzed.All patients underwent emergent interventional embolization with gelatin sponge particles and micro-coils.Results There was no obvious contrast staining or accumulation in 14 patients.In the delayed phase,a total of 34 small arteries with slight staining were found.Obvious contrast media spillover signs were found with superselective catheterization.The hemostasis was successful after interventional embolization.Two patients died of hemorrhagic shock,severe acidosis and multiple organ failure after treatment.Conclusion Superselective interventional embolization is an effective hemostatic measure for concealed hemorrhage of small artery injury in patients with pelvic fracture.Delayed phase angiography can improve the detection rate of small artery injury.