探讨创伤性脾破裂行脾切除术的影响因素

Investigate on the influencing factors of splenectomy for traumatic splenic rupture

目的 探讨创伤性脾破裂行脾切除术的影响因素。方法 选择2019年1月—2022年1月本院急诊外科收治的创伤性脾破裂患者98例作为研究对象,根据不同治疗方式分为脾切除组(64例)和保脾组(34例)两组。比较两组患者年龄、性别、CT分级、入院时收缩压、脉搏、休克指数、肌酸激酶同工酶(CK-MB)水平、腹腔穿刺情况是否具有差异性,并进一步采用Logistics回归分析对创伤性脾破裂治疗方式的影响因素,并比较两组患者住院时间、并发症发生率的差异性。结果 两组患者住院时间比较,脾切除治疗的患者恢复快,住院时间低于保脾组,差异具有统计学意义(P<0.05),所有患者脾切除比例为65.3%(64/98)。脾切除组患者并发症发生率低于保脾组(6.12%vs 9.18%,P=0.025)。单因素分析发现CK-MB水平、入院时收缩压、脉搏、休克指数、CT分级、腹腔穿刺与治疗方式的选择密切相关;多因素非条件Logistics回归分析显示,CK-MB(OR=463.091,95%CI:6.764-31706.44)、腹腔穿刺情况(OR=104.289,95%CI:3.538-3073.840)是影响治疗方式重要的因素。结论 创伤性脾破裂患者术前可根据CK-MB水平、腹腔穿刺情况、CT分级、入院时收缩压、脉搏、休克指数来综合评估脾破裂治疗方式,其中,CK-MB的水平可能为脾破裂的治疗方式提供参考。

Objective To explore the influence factors of splenectomy for traumatic splenic rupture.Methods A total of 98 patients suffered with traumatic splenic rupture those were admitted to the emergency surgery department of our hospital from January 2019 to January 2022 were collected as study subjects.According to different treatment methods,they were assigned into splenectomy group and spleen preservation group,64 patients underwent splenectomy,while 34 patients were treated with spleen preservation.The age,gender,CT grade,systolic blood pressure at admission,pulse,shock index,creatine kinase isoenzyme(CK-MB)level,abdominocentesis were compared between the two groups.Logistic regression was used to analyze the influence of the above data on treatment methods,and to compare the differences in hospitalization time and complication rate between the two groups.Results In terms of comparing the hospitalization time of the two groups of patients,the patients who underwent surgery recovered faster,the length of hospital stay was shorter than that of the spleen preservation group,and the difference was statistically significant(P<0.05).The proportion of patients undergoing splenectomy was 65.3%(64/98).The incidence of complication in the splenectomy group was lower than that in the spleen preservation group(6.12%vs 9.18%,P=0.025).Univariate analysis showed that CK-MB level,systolic blood pressure at admission,pulse,shock index,CT grade,abdominocentesis were closely related to the choice of treatment method.Multivariate unconditional logistic regression analysis showed that CK-MB(OR=463.091,95%CI:6.764-31706.44),abdominocentesis(OR=104.289,95%CI:3.538-3073.840)are important factors affecting the treatment method.Conclusions In patients with traumatic splenic rupture,the treatment of splenic rupture could be comprehensively evaluated according to the level of CK-MB,abdominal puncture,CT grade,systolic blood pressure on admission,pulse,and shock index before surgery.Among them,the level of CK-MB may provide a reference for the treatment of splenic rupture.