经导管动脉栓塞术在骨盆骨折并大出血急救中的临床应用

The application of transcatheter artery embolization in haemorrhage due to pelvic fracture

目的 探讨经导管动脉栓塞术在骨盆骨折合并大出血急救中的临床应用。方法 搜集19例骨盆骨折并发盆腔大出血休克的患者 ,男 11例 ,女 8例 ,年龄 18～ 46岁 ,平均 2 8岁。术前血压为(40～ 90 ) /(0～ 60 )mmHg (1mmHg =0 13 3kPa) ,急诊行出血动脉和 (或 )髂内动脉主干栓塞术 ,其中2例伴有脾破裂患者同时行脾动脉栓塞术。术后严密观察生命体征的变化 ,并进行必要的外科处理。结果 15例患者可见明显的对比剂外溢 ,出血动脉为髂内动脉主干 3例 ,臀上动脉 5例 ,阴部内动脉或闭孔动脉 7例 ;2例表现为髂内动脉分支中断 ,2例血管造影未见明显阳性表现。全部 19例均在 1h内完成栓塞治疗 ,术后 2 4h内全部患者血压逐步回升至正常水平 [(90～ 12 0 ) /(60～ 90 )mmHg]。未出现严重的栓塞并发症。 1例于血压稳定后行膀胱直肠手术修补时死亡 ,3例于 72h内死于弥漫性血管内凝血 (DIC)。结论 经导管动脉栓塞术是骨盆骨折大出血的 1种安全、迅速。

Objective To evaluate the value of transcatheter artery embolization (TAE) in the control of haemorrhage due to pelvic fracture Methods TAE was carried out in 19 patients with haemorrhage due to pelvic fracture All the patients had shock with the blood pressure (40～90)/(0～60) mm Hg Two patients underwent the embolization of splenic artery at the same time Results The extravasation of the contrast agent appeared in 15 patients in the arteriography The time of TAE was less than 60 min The blood pressure of these 19 patients increased steadily after the operation All were cured with the help of effective emergency treatment,except 3 patients died of DIC in 72 h and 1 patient died during successive operation. Conclusion TAE is a safe and effective method in controlling haemorrhage due to pelvic fracture, and the survival rate is affected respectively by the following clinical management