多学科协作团队模式下靶向介入栓塞治疗骨盆与髋臼骨折所致失血性休克的效果分析
Targeted interventional embolization therapy for hemorrhagic shock caused by pelvic fracture or/and acetabular fracture by a multidisciplinary team
刘亮 1师佩璐 2宋浪 3裴亮 4刘广生 5张永红 1孙海钰1
作者信息
- 1. 山西医科大学第二医院骨科,太原 030000
- 2. 山西医科大学第二医院介入科,太原 030000
- 3. 山西医科大学第二医院普外科,太原 030000
- 4. 山西医科大学第二医院泌尿科,太原 030000
- 5. 山西医科大学第二医院神经外科,太原 030000
- 折叠
摘要
目的 探讨多学科协作团队模式下靶向介入栓塞治疗急性期骨盆与髋臼骨折所致失血性休克的临床疗效.方法 回顾性分析2015年1月至2022年7月期间山西医科大学第二医院骨科收治的63例骨盆与髋臼骨折所致失血性休克患者资料.男44例,女19例;年龄(39.6±15.6)岁;骨盆骨折23例,髋臼骨折35例,骨盆合并髋臼骨折5例.受伤至靶向介入栓塞治疗时间为2.67(2.00,3.33)h.所有患者均在骨科、介入科、普外科及泌尿科等多学科协作团队模式下采用靶向介入栓塞治疗.记录患者治疗后12 h内的休克指数和乳酸值、24 h尿量及治疗后3周内并发症的发生情况等.结果 63例患者栓塞后未再发现出血,治疗后12 h内休克指数≤1.0,休克得到纠正.63例患者靶向介入栓塞治疗后12 h内休克指数(0.70±0.46)、乳酸值[(2.03±1.35)mmol/L]显著低于治疗前[(1.76±0.56)、(4.53±1.74)mmol/L],24 h 尿量[(50.26±20.38)mL/h]显著多于治疗前[(21.56±1.27)mL/h],差异均有统计学意义(P＜0.05).2例患者出现(足母)趾远端皮肤血运不良,经活血、抗凝治疗后缓解;3例患者出现髋部软组织坏死,经多次清创、抗感染治疗后患者得到痊愈;1例损伤严重患者因发生多器官功能障碍而死亡.结论 靶向介入栓塞治疗不仅可以诊断骨盆与髋臼骨折所致失血性休克患者的出血位置,还能及时、准确地止血,纠正休克;同时多学科协作团队模式可以使患者避免多次手术,减轻患者的痛苦和经济损失.
Abstract
Objective To explore the clinical efficacy of targeted interventional embolization therapy by a multidisciplinary team for the hemorrhagic shock caused by acute pelvic fracture or/and acetabular frac-ture.Methods A retrospective study was conducted to analyze the data of 63 patients with hemorrhagic shock caused by pelvic fracture or/and acetabular fracture who had been admitted to Department of Orthopaedics,The Second Hospital of Shanxi Medical University from January 2015 to July 2022.There were 44 males and 19 females with an age of(39.6±15.6)years,and 23 pelvic fractures,35 acetabular fractures,and 5 pelvic and acetabular fractures.The time from injury to targeted interventional embolization therapy was 2.67(2.00,3.33)hours.All the patients were treated with targeted interventional embolization therapy by a multidisci-plinary team involving orthopedics,interventional medicine,general surgery,and urology.The shock index and lactate level within 12 hours after therapy,24-hour urine output,and incidence of complications 3 weeks after therapy were recorded.Results No bleeding was found again in the 63 patients after embolization.Within 12 hours after therapy,the shock index was ≤1.0,indicating the shock was corrected.Within 12 hours after targeted interventional embolization therapy,the shock index(0.70±0.46)and lactate value[(2.03±1.35)mmol/L]in the 63 patients were significantly lower than those before therapy[(1.76±0.56)and(4.53±1.74)mmol/L](P＜0.05).The 24-hour urine output[(50.26±20.38)mL/h]was signifi-cantly higher than that before therapy[(21.56±1.27)mL/h](P＜0.05).Two patients experienced poor blood circulation in the distal skin of the great toe,which was relieved after treatment with blood circulation promotion and anticoagulation.Three patients developed necrosis of the hip soft tissue,which was cured after multiple times of debridement and anti-infection treatments.One patient with severe injury died from multiple organ dysfunction.Conclusions The targeted interventional embolization therapy can not only diagnose the bleeding location in patients with hemorrhagic shock caused by pelvic fracture or/and acetabular fracture,but also timely and accurately carry out hemostatic treatment to correct shock.Moreover,a multidisciplinary team can help patients avoid multiple surgeries and decrease their pain and financial loss.
关键词
休克,出血性/放射学,介入性/栓塞,治疗性/骨盆/髋臼/骨折/多学科协作团队Key words
Shock,hemorrhagic/Radiology,interventional/Embolization,therapeutic/Pelvis/Acetabulum/Fractures,bone/Multidisciplinary team引用本文复制引用
出版年
2024
NETL
NSTL
万方数据