【作者】 王栋；

【导师】 唐杰；

【作者基本信息】 南开大学 ， 肿瘤学， 2013， 博士

【摘要】 目的：1、通过超声造影引导下注射止血剂治疗腹部实质性脏器创伤治疗前后患者各项指标变化情况,探讨应用该治疗方法后患者预后情况,评价预后效果。2、通过超声造影引导下注射止血剂治疗腹部实质性脏器创伤与常规手术治疗腹部实质性脏器创伤治疗后患者各项指标变化情况,探讨该方法与常规手术治疗相比优势,并评价其安全性。3、通过近年超声造影引导下注射止血剂治疗腹部实质性脏器创伤累积的临床积累,讨论其适应证和临床经验。方法：1、超声造影引导下注射止血剂治疗腹部实质性脏器创伤与常规手术治疗预后对比研究：(1)、对比超声造影引导下注射止血剂治疗腹部实质性脏器创伤治疗前后患者各项指标。(2)、对比超声造影引导下注射止血剂治疗腹部实质性脏器创伤与常规手术治疗腹部实质性脏器创伤治疗后各项指标对比指标如下：(1)、基本资料及人口学数据(2)、病史、现状(3)、病史记录2、超声造影引导下注射止血剂治疗腹部实质性脏器创伤适应证探讨及技巧等相关分析：通过分析超声造影引导下注射止血剂治疗腹部实质性脏器创伤患者情况,探讨该治疗方法适应证及治疗相关技巧。结果：1、超声造影引导下注射止血剂治疗腹部实质性脏器创伤与常规手术治疗预后对比研究：(1)、对比超声造影引导下注射止血剂治疗腹部实质性脏器创伤治疗前后患者各项指标。分析主要指标可得出：在止血剂组治疗前后对比两组数据中,治疗后收缩压、呼吸频率、红细胞、红细胞比积、血红蛋白、葡萄糖,P<0.05,有统计学意义。pH、白细胞、血小板、天冬氨酸氨基转移酶、总胆红素、直接胆红素、尿素、肌酐、凝血酶原时间、钾,P<0.0l,有显著统计学意义。(2)、通过对比超声造影的引导下注射止血剂治疗腹部脏器肝脾肾创伤与常规手术治疗治疗后各项指标。分析主要指标可得出：住院天数、收缩压、心率、呼吸频率、血小板、凝血酶原时间、钙存在差异,P<0.05,有统计学意义。两组在白细胞、淀粉酶、尿素、活化部分凝血活酶时间方面存在显著差异,P<0.01,有显著统计学意义。(3)、在所有患者受伤原因中,除去其他情况或未记录的情况,车祸是发生创伤的主要因素,其次是坠落伤。结论：1、超声造影引导下注射止血剂治疗腹部实质性脏器创伤与常规手术治疗预后对比研究：①在创伤患者中,男性发生创伤多于女性,并且从年龄方面发生创伤以中青年居多。②车祸是创伤主要的因素之一。③在超声造影引导下,在注射止血剂治疗腹部肝脾肾创伤中,患者在应用了本方法经治疗后,不仅起到了止血的效果,同时各项生命体征等各项指标都有不同程度的改善。④与常规手术治疗相比,超声造影引导下注射止血剂治疗腹部实质性脏器创伤是一种便于床旁操作,效益比高,在取得相同效果的同时还能避免脏器摘除风险的治疗方法。2、超声造影引导下注射止血剂治疗腹部实质性脏器创伤适应证探讨及技巧等相关分析：通过近年临床实践总结得出其适应证：(1)患者肝、脾、肾创伤Ⅱ级伴活动性出血、Ⅲ级或Ⅳ级考虑采用止血剂治疗。(2)患者年龄最好在18-55岁之间,年龄大者谨慎治疗。(3)血红蛋白应在70g/L以上,患者无原发性血液疾病等。(4)发生脏器创伤到治疗时间不宜过长,不易超过8小时,迟发性脏器破裂除外。更多还原

【Abstract】 Purpose:1. Based on changes of every indicator of patients with abdomen solid visceral trauma (ASVT) before and after contrast-enhanced ultrasound-guided injections of hemostatic agents (HA treatment), to probe into patients’ recovery after such treatment and evaluate prognosis.2. By comparing changes of every indicator of ASVT patients receiving HA treatment with those receiving traditional surgery treatment, to discuss advantages of the former over the latter and evaluate the safety of HA treatment.3. To shed light on the indications and clinical experience of HA treatment for ASVT based on recent clinical practice.Methodologies:1. A comparison between the prognosis after HA treatment with that after traditional surgery treatment for ASVT:(1) Comparing ASVT patient indicators before and after HA treatment.(2) Comparing ASVT patient indicators after HA treatment with those after traditional surgery treatment.Comparative indicators are as follows:(1) Basic information and demographic data(2) Medical history and current conditions(3) Medical history record2. Discussion on indications and analysis of relevant techniques for HA treatment for ASVT:By analyzing the conditions of ASVT patients receiving HA treatment, probe into the indications of this therapy and relevant techniques.Results:1. A comparison between the prognosis after HA treatment with those after traditional surgery treatment for ASVT:(1) Comparing every indicator of ASVT patients before and after HA treatment. After analyzing main indicators, it can be found that:For the two sets of data of the HA treatment group before and after the treatment, the systolic blood pressure, respiratory rate, RBC, Hematocrit, hemoglobin, and glucose (P<0.05) have statistical significance. The pH, WBC, platelet, AST, Total bilirubin, direct bilirubin, carbamide, creatinine, PT and K+(P<0.01) have great statistical significance.(2) Comparing ASVT patient indicators after HA treatment with those after traditional surgery treatment. After analyzing main indicators, it can be found that:In terms of patients’ length of hospitalization, systolic blood pressure, Heart rate, respiratory rate, platelet, PT and Ca2+(P<0.05) have statistical significance. The hospitalization expenses, WBC, amylase, carbamide and APTT (P<0.01) have great statistical significance.(3) For the causes of all patients’injuries, traffic accident is the main factor followed by fall injury.Conclusion:1. Through a comparative study on the prognosis after HA treatment with that after traditional surgery treatment for ASVT, it’s found that:①Among patients with trauma, the occurrence in male is more frequent than female, and in aspects of age, young and middle-aged are predominant.②Traffic accident is the main reason for trauma.③After HA treatment for ASVT, the patients not only achieve the effect of hemostasis, but also are improved in all indicators including vital signs to some extent.④Compared with traditional surgery, HA treatment for ASVT is a therapeutic method easy for bedside operation with high benefit, and which not only achieves the expected results but also avoids organ removal.2. Discussion on indications and analysis of relevant techniques for HA treatment for ASVT:Its indications are concluded as follows based on clinical practice in recent years:(1) whether the patient suffers liver, spleen or kidney trauma and the trauma level; it’s recommended that HA treatment is adopted for the patient of Level-Ⅱ associated with active bleeding, Level-Ⅲ and Level-Ⅳ;(2) the age of patient is better at the range of18-55, and caution is required when a patient of older age is receiving treatment;(3) it’s better that the hemoglobin is more than70g/L, no primary disease of the blood;(6) the time from trauma occurrence to treatment shall not be too long, best within8hours. Except for late-onset viscera rupture.更多还原