介入性治疗对外伤性脾破裂的有效性及出血量的影响

石哲; 晋小祥; 朱国清; 赵应龙

doi:10.13898/j.cnki.issn.1000-2200.2021.09.025

介入性治疗对外伤性脾破裂的有效性及出血量的影响

Effect of interventional therapy on the effectiveness of traumatic splenic rupture and the amount of blood loss

摘要

摘要:
目的探讨介入性治疗对外伤性脾破裂病人的有效性及病人出血量的影响。
方法选择68例外伤性脾破裂病人作为研究对象，采取随机双盲方法分为对照组和观察组，各34例。对照组给予外科手术治疗，观察组给予选择性介入栓塞手术治疗，2组术后5 d对病人效果进行评估，术后对病人进行6个月随访。比较2组手术指标、视觉模拟评分法（VAS）评分、炎症因子、生活质量。
结果无转开腹或者再手术发生；2组手术时间差异无统计学意义（P>0.05）；观察组肛门排气、住院时间、术中出血量、住院费用及术后进食时间均明显短（少）于对照组（P < 0.01）；2组术后1、3、5、7 d VAS评分均明显低于手术前（P < 0.01）；观察组术后1、3、5、7 d VAS评分均明显低于对照组（P < 0.01）；2组术后5 d白细胞计数、C反应蛋白（CRP）、皮质醇（Cor）及肾上腺素（EP）水平均高于术前（P < 0.05）；观察组术后5 d白细胞计数、CRP、Cor及EP水平均低于对照组（P < 0.01）；2组术后5 d QOL评分均高于术前（P < 0.05~P < 0.01）；观察组术后5 d生理机能、生理智能、躯体疼痛、一般健康状况、精力、社会功能、情感智能及精神健康评分均明显高于对照组（P < 0.01）。
结论介入性治疗用于外伤性脾破裂病人中，病人出血量较小，能减轻病人疼痛，降低炎症因子水平，有助于病人生活质量的提高，且该治疗方法安全性较高，能降低术后复发率，值得推广应用。

Abstract:
ObjectiveTo investigate the effectiveness of interventional therapy in patients with traumatic splenic rupture and the effect of the amount of blood loss.
MethodsA total of 68 patients with traumatic splenic rupture were selected as subjects, and randomly divided into the control group(n=34) and the observation group(n=34) using a double-blind randomized method.The control group received surgical treatment, while the observation group received selective interventional embolization.The effect of the two groups was evaluated at 5 days after operation, and the patients were followed up for 6 months after operation.Surgical indicators, VAS scores, inflammatory factors, and quality of life were compared between the two groups.
ResultsNo laparotomy or reoperation occurred.There was no statistical significance in the operation time between the two groups(P>0.05).In the observation group, anal exhaust, hospital stay, intraoperative blood loss, hospital expenses and postoperative feeding time were shorter (less) than those in the control group(P < 0.01).Postoperative scores of 1, 3, 5 and 7 d VAS in both groups were lower than those before surgery (P < 0.01).Postoperative scores of 1, 3, 5 and 7 d VAS in the observation group were all lower than those in the control group(P < 0.01).White blood cell count, CRP, Cor and EP levels were higher in both groups at 5 d after operation than before(P < 0.05).The white blood cell count, CRP, Cor and EP levels in the observation group were all lower than those in the control group 5 days after operation(P < 0.01).The 5 d QOL score after operation was higher in both groups than before nursing(P < 0.05 to P < 0.01).The scores of 5 d PH, RP, BP, GH, VT, SF, RE and MH in the observation group were all higher than those in the control group(P < 0.01).
ConclusionsInterventional therapy can reduce the amount of bleed loss in patients with traumatic splenic rupture, relieve the pain, reduce the level of inflammatory factors, and contribute to the improvement of patients' quality of life.Moreover, this treatment method is safe and can reduce the postoperative recurrence rate, which is worthy of popularization and application.

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