基于主动脉CT血管成像的钝性主动脉损伤分级在临床决策中的指导价值

Guiding value of blunt aortic injury classification based on aortic computed tomographic angiography imaging in clinical decision-making

目的:探讨基于主动脉CT血管成像的钝性主动脉损伤(BAI)分级方案,在主动脉损伤的临床决策中的指导价值。方法:回顾性分析北京安贞医院2015年10月至2019年6月临床确诊和疑诊为主动脉损伤的患者,对其影像学资料及临床资料进行分析评估。影像学资料的评估参照一是美国血管外科学会(SVS)指南中的BAI分级,参照二是判断其是否符合影像学严重损伤(RSI)的标准。临床资料的回顾性分析则包括:患者的一般情况、复合伤以及治疗策略(是否手术、手术时机)。观察主动脉损伤影像学分级对治疗策略的影响。结果:在入选的52例中,39例合并其他损伤,其余13例为单纯主动脉损伤。CTA影像学上,2例为SVS-Ⅳ级,33例Ⅲ级,8例Ⅱ级,2例Ⅰ级,2例为冠状动脉损伤,余下5例CTA上主动脉未见明确异常征象。16例(包括SVSⅠ-Ⅲ级)进行保守治疗,临床症状及CTA影像随访均提示病情稳定、好转,随访期间内均未出现病变进展的情况;10例影像学上对比剂外溢,或假性动脉瘤>1.5 cm的患者在受伤后的7 d内进行了手术或介入治疗;12例影像学上表现为慢性假性动脉瘤,除1例采取保守治疗外,余下11例均进行手术或介入治疗;13例符合放射学严重损伤的定义,7例于就诊后24 h内接受了手术治疗,2例于就诊后7 d内接受了手术治疗,其余4例死亡。结论:SVSⅠ~Ⅲ级保守治疗并不增加死亡风险,放射学严重损伤者则需及时的手术或介入治疗干预;SVS-BAI分级结合RSI影像征象的放射学评估为主动脉损伤的急性管理提供一种简易的方法,为临床分诊患者,并对治疗决策提供指导性的意义。

Objective:To explore the guiding value of blunt aortic injury(BAI)classification based on aortic CT angiography in clinical decision-making.Methods:We conducted a retrospective database review to all patients with clinically confirmed and suspected BAI between October 2015 and June 2019 in Beijing Anzhen Hospital,and their imaging data and clinical data were collected and analyzed.The evaluation of imaging data includes two aspects,blunt aortic injury grade as defined by the Society for Vascular Surgery(SVS)and whether it is defined as radiographic severe injury(RSI).Retrospective analysis of clinical data includes the general condition of the patient,compound injuries,and treatment strategies(including whether surgery,timing of surgery).Observe the impact of BAI imaging grading on treatment strategies.Results:Of 52 patients with BAI.39 patients were combined with other injuries,the remaining 13 patients were only aortic injuries.2 patients had grade Ⅳ injuries on CTA,33 grade Ⅲ injuries,8 grade Ⅱ injuries,2 grade I injuries,2 patients presented with coronary artery injury,and no injury was observed on the aortic CTA in the remaining 5 cases.16 patients(grade Ⅰ-Ⅲ injuries)managed nonoperatively,the clinical and radiographic outcomes remained stable or were improved during the follow-up.10 patients underwent surgery or interventional therapy within 7 days after injury,these patients or showed active contrast extravasation,or pseudoaneurysm larger than 1.5 cm.12 patients showed chronic pseudoaneurysms on CTA,except for one patient who managed nonoperatively,the remaining 11 patients underwent surgery or interventional therapy.13 patients had RSI,7 patients underwent surgery within 24 hours,2 patients underwent surgery within 7 days,and the other 4 patients died.Conclusions:The conservative treatment of SVS Ⅰ-Ⅲ injuries does not increase the risk of death.Patients who had RSI need timely surgery or interventional therapy.SVS-BAI classification combined with RSI radiological assessment provides a simple method for the acute management of aortic injury,provides clinical triage for patients,and provides guidance for treatment decisions.