介入栓塞对骨盆骨折引起失血性休克患者围术期指标、术后并发症及血清超敏C反应蛋白、超氧化物歧化酶水平的影响

Effects of interventional embolization on perioperative indexes,postoperative complications,serum hypersensitive C-reactive protein and superoxide dismutase levels in patients with hemorrhagic shock caused by pelvic fracture

目的探讨介入栓塞在骨盆骨折引起失血性休克患者中的应用效果。方法选取2021年2月至2023年5月山西医科大学第二医院接收的骨盆骨折引起失血性休克患者62例为研究对象, 根据治疗方法分为对照组30例(常规外科治疗)、观察组32例(介入栓塞治疗)。比较2组围术期指标、凝血功能指标[纤维蛋白原(FIB)、凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血酶原时间(APTT)]、炎性因子水平[血清超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)]、氧化应激因子[血清超氧化物歧化酶(SOD)、丙二醛(MDA)]、术后并发症发生率。计量资料采用t检验, 计数资料采用χ^(2)检验。结果观察组术中输血量、术中输液量[(1 214.33±325.47)、(2 576.74±372.19) ml]少于对照组[(2 348.68±430.92)、(4 450.53±413.82) ml, t=11.743、18.768, P<0.05], 观察组休克纠正时间[(2.78±0.38) h]短于对照组[(10.96±2.85) h, t=49.443, P<0.05];治疗4 h后, 观察组FIB[(2.56±0.93) g/L]低于对照组[(3.41±0.96) g/L, t=3.541, P<0.05], 观察组PT、TT、APTT[(12.45±2.38)、(15.48±2.34)、(36.46±4.50) s]长于对照组[(10.58±1.86)、(13.29±1.67)、(29.15±3.92) s, t=3.431、4.216、6.801, P<0.05];治疗7 d后, 观察组血清hs-CRP、TNF-α、MDA[(7.85±0.63) mg/L、(126.31±23.56) pg/ml、(5.74±1.37) U/L]低于对照组[(10.44±0.76) mg/L、(145.93±26.48) pg/ml、(9.88±1.52) U/L, t=14.646、3.086、11.278, P<0.05], 观察组血清SOD[(74.85±10.19) U/ml]高于对照组[(68.34±9.20) U/ml, t=2.634, P<0.05];两组术后并发症发生率[18.75%(6/32)比13.33%(4/30)]比较差异无统计学意义(χ^(2)=0.055, P>0.05)。结论介入栓塞应用于骨盆骨折引起失血性休克患者中, 可减少输血量、输液量, 缩短休克纠正时间, 改善凝血功能, 减轻氧化应激反应与炎性反应, 且安全性高。

Objective To investigate the effect of interventional embolization in patients with hem-orrhagic shock caused by pelvic fracture.Methods From February 2021 to May 2023,62 patients with hemorrhagic shock caused by pelvic fracture were selected as the research objects.They were included strictly based on inclusion and exclusion criteria,and were divided into control group(n=30,conventional surgical treatment)and observation group(n=32,interventional embolization)according to treatment methods.Perioperative indexes,coagulation function indexes[fibrinogen(FIB),prothrombin time(PT),thrombin time(TT),activated partial prothrombin time(APTT)],inflammatory factor levels[serum hypersensitive C-reactive protein(hs-CRP),tumor necrosis fact-α(TNF-α)],oxidative stress degree[ser-um superoxide dismutase(SOD),malondialdehyde(MDA)],incidence of postoperative complications were compared between two groups.T test was used for measurement data,and x^(2)test was used for counting data.Resultss The amount of intraoperative blood transfusion and infusion in the observation group[(1214.33±325.47),(2576.74±372.19)ml]was less than that in the control group[(2348.68±430.92),(4450.53±413.82)ml,t=11.743,18.768,P<0.05],and the correction time of shock[(2.78±0.38)h]was shorter than that in the control group[(10.96±2.85)h,t=49.443,P<0.05].After treatment for 4 h,the FIB level in the observation group[(2.56±0.93)g/L]was lower than the control group[(3.41±0.96)g/L,t=3.541,P<0.05],and the PT,TT and APTT in the observation group[(12.45±2.38),(15.48±2.34),(36.46±4.50)s]were longer than the control group[(10.58±1.86),(13.29±1.67),(29.15±3.92)s,t=3.431,4.216,6.801,P<0.05].After 7 days of treatment,the levels of serum hs-CRP,TNF-αand MDA in the observation group[(7.85±0.63)mg/L,(126.31±23.56)pg/ml,(5.74±1.37)U/L]were lower than those in the control group[(10.44±0.76)mg/L,(145.93±26.48)pg/ml,(9.88±1.52)U/L,t=14.646,3.086,11.278,P<0.05],and the level of serum SOD in the observation group[(74.85±10.19)U/ml]was higher than that in the control group[(68.34±9.20)U/ml,t=2.634,P<0.05].There was no significant difference in the incidence of postoperative complications between the two groups[18.75%(6/32)vs.13.33%(4/30),P>0.05].Conclusion Interventional embolization in patients with hemorrhagic shock caused by pelvic fracture can reduce the amount of blood transfusion and infusion,shorten the time of shock correction,improve coagulation function,alleviate oxidative stress and inflammatory reaction,and has high safety.