脾破裂伤情评估及其临床意义

目的 :在术前对脾破裂患者的伤情进行评估 ,根据评估结果选择正确的治疗方法 ;探讨非手术治疗脾破裂的指标。方法 :通过分析术中测定的脾破裂类型 (traumaticsplenicruptruetypesTSRT)、失血量 (hemorrhagicvolumeHV)、失血速度 (hemmorhagicspeedHS)之间的相互关系 ,确定它们共同作用的结果是否导致围手术期失代偿性休克 (perioperativedecompensationalshockPODS)发生及PODS时间的对应关系 ,产生术前评估脾破裂伤情的客观指标。选择部分脾破裂患者进行非手术治疗 ,检验评估的正确性。结果 :PODS在TSRT ,HV ,HS各组别间的分布差异性显著 (P <0 .0 5 ,P <0 .0 1) ,TSRT与HS和PODS关系密切 ,各组别间差异性显著 (P <0 0 5 )。非手术治疗 13例中 ,治愈 9例 (70 % ) ,中转手术 4例 (30 % )。结论 :PODS和PODS时间与TSRT ,HV ,HS及TSRT ,HV ,HS之间呈正相关关系 ,根据PODS是否发生及PODS时间 ,术前能评估脾破裂伤情。脾破裂 1级适宜非手术治疗

An Estimate of Condition to Patients with Traumatic Splenic Ruptrue and Its Clinical Effects

Objective:To evaluate condition of patients with traumatic splenic ruptrue preoperatively to select coorect treatmentand and find a traget for conservative treatment of traumatic splinic ruptrue. Methods: Through analysis of the mutual relation between traumatic splenic ruptrue types(TSRT) and hemorrhagic volume(HV), hemorrhagic speed(HS), the corresponding relation of these factor joint action whether or not lead up to perioperative decompensation shock(PODS). PODS and PODS time were determined, and produced the objective target PODS that evaluate condition of palients with traumatic splenic ruptrue preoperatively. The 13 cases patients of with traumatic splenic rupture were treated with conservative trentment to examine this evaluation. Results: Distribution differences of PODS among groups of the HS, HV, TSRT were all significant statiscally (P<0.05-P<0.01). The relationship between the TSRT and HS or and PODS was intimate (P<0.05). The 9 cases of 13 cases with conservative treatment were cured(70%), the 4 cases changed into operation (30%). Conclusions: The interrelation between PODS ,PODS time, TSRT, HV, HS, and between TSRT, HV, HS presented all direct interrelation. The condition of the patients with traumatic splentic ruptrue were evaluated preoperatedly according to PODS and PODS time. The patients of one type traumatic splenic ruptrue were indication with conservative treatment.