急诊血管介入栓塞治疗创伤性血流动力学不稳定型骨盆骨折效果分析

Effect of emergency vascular interventional embolization in treatment of traumatic hemodynamically unstable pelvic fractures

目的分析急诊血管介入栓塞治疗创伤性血流动力学不稳定型骨盆骨折的效果。方法对124例创伤性骨盆骨折伴血流动力学不稳定的患者进行研究分析,男59例,女65例,平均年龄(33.5±2.8)岁;致伤原因:交通事故76例、高处坠落27例、其他21例,根据患者选择治疗方法的不同分为采用传统保守治疗方法的对照组(n=61)和采用介入性血管栓塞术的观察组(n=63)。比较术前、术后两组患者血流动力学指标情况。比较两组手术时间、术中出血量、住院天数以及并发症发生情况。术后3个月时,采用Majeed骨盆骨折功能评分和欧洲五维健康量表(EQ-5D)评估患者的手术疗效和生活质量。结果两组间一般资料无明显差异。观察组术后心率、血乳酸盐较对照组下降更为明显(P<0.001);观察组术后收缩压、中心静脉压较对照组均显著升高(P<0.001)。术后1年后随访,对照组与观察组Majeed评分和EQ-5D指数均显著优于术前(P<0.05);观察组Majeed评分和EQ-5D指数显著低于对照组(均P<0.001)。结论急诊血管介入栓塞治疗对于创伤性血流动力学不稳定型骨盆骨折患者具有较好效果,可为临床抢救、治疗提供良好的条件。

Objective To analyze the effect of emergency interventional vascular embolization in the treatment of hemodynamically unstable pelvic fractures.Methods A total of 124 patients with traumatic pelvic fractures and hemodynamic instability were enrolled in the study.There were 59 males and 65 females,with an average age of(33.5±2.8)years.Causes of injury:76 cases of traffic accidents,27 cases of falling from heights,and 21 other cases.According to different treatment methods,the patients were divided into a control group(n=61)using traditional conservative treatment and an observation group(n=63)using interventional vascular embolization.The hemodynamic indicators of the two groups of patients before and after surgery were compared.The operation time,intraoperative blood loss,hospitalization days,and complications were compared between the two groups.The Majeed pelvic fracture function score and the European quality of life-5 dimensions scale(EQ-5D)were used to evaluate the surgical efficacy and quality of life of the patients 3 months after surgery.Results There was no significant difference in general information between the two groups.The postoperative heart rate and blood lactate of the observation group decreased more significantly than those of the control group(P<0.001);the postoperative systolic blood pressure and central venous pressure of the observation group were significantly increased compared with the control group(P<0.001).At the follow-up one year after operation,the Majeed score and EQ-5D index of the control group and the observation group were significantly better than those before operation(P<0.05).The Majeed score and the EQ-5D index of the observation group were significantly lower than those of the control group(P<0.001).Conclusion Emergency vascular interventional embolization has a good effect on patients with traumatic hemodynamically unstable pelvic fractures,which provides good conditions for clinical rescue and treatment.