创伤性脾破裂行保脾治疗的预后风险分析——单中心195例回顾性研究

Prognostic risk analysis of splenic preservation therapy for traumatic splenic rupture:a retrospective study of 195 cases in a single center

目的研究影响创伤性脾破裂行保脾治疗效果的风险因素,为临床工作提供指导。方法回顾性分析2018年1月至2020年12月浙江大学医学院附属第二医院余姚分院收治的创伤性脾破裂患者的基础资料、影像数据及预后,利用logistic回归对保脾与脾切除患者的各项数据进行单因素及多因素回归分析,阐明影响创伤性脾破裂患者行保脾治疗的显著性风险因素。结果研究纳入创伤性脾破裂病例共195例,其中男性140例(71.79%),平均年龄47.07岁(11-87岁)。合并其他器官损伤患者148例(75.9%),其中腹腔其他脏器损伤26例(13.33%),胸部损伤126例(64.62%),颅脑损伤38例(19.49%),四肢骨盆损伤46例(23.59%)。成功救治患者193例(98.97%),其中保脾治疗145例(75.13%),脾切除术48(24.87%,5例为介入治疗失败后行脾切除术)。多因素分析发现,休克指数(shock index,SI)、ISS(Injury Severity Scale)/AIS(The Abbreviated Injury Scale)评分值、脾损伤CT分级等3项指标为影响脾破裂患者保脾治疗预后的显著性风险因素(P<0.05)。结论本研究发现,休克指数小于1、ISS/AIS评分<25分,及CT分级1-3级的脾破裂患者,应积极予以保脾,保脾成功率可达95%以上。

Objective To analyze the risk factors of splenic preservation therapy for traumatic splenic rupture in order to provide guidance for clinical work.Methods We retrospectively analyzed the basic data,imaging data and prognosis of patients with traumatic splenic rupture admitted to our hospital from January 2018 to December 2020,and conducted univariate and multivariate logistic regression analysis on the data of patients with splenic preservation and splenectomy.The results were used to elucidate the significant risk factors influencing the treatment of traumatic splenic rupture.Results A total of 195 cases of traumatic splenic rupture were included in this study,including 140 males(71.79%)with an average age of 47.07 years(11-87 years).There were 148 patients(75.9%)with other organ injury,including 26 patients(13.33%)with other abdominal organ injury,126 patients(64.62%)with chest injury,38 patients(19.49%)with craniocerebral injury,and 46 patients(23.59%)with pelvis injury.193 patients(98.97%)were cured and discharged from hospital,including 145 patients(75.13%)with spleen-preserving therapy and 48 patients(24.87%)with splenectomy(5 patients underwent splenectomy after interventional therapy failure).Multivariate analysis found that SI(shock index),ISS(Injury Severity Scale)/AIS(The Injury Scale)score value,CT grading of splenic injury were significant risk factors affecting the prognosis of splenic rupture treatment(P<0.05).Conclusion Patients with splenic rupture whose shock index is less than 1,ISS/AIS score is less than 25,and CT grade 1-3 should be actively treated for splenic preservation,and the success rate of splenic preservation can reach more than 95%.