【摘要】：目的研究不同脾保留術(shù)治療外傷性脾破裂失血性休克的臨床效果和對(duì)免疫功能影響。方法研究對(duì)象選取我院2015年1月至2017年2月間收治的外傷性脾破裂失血性休克患者85例,分別采用脾修補(bǔ)手術(shù)(40例,A組)和脾動(dòng)脈栓塞術(shù)治療(45例,B組),另選取同時(shí)間段的健康獻(xiàn)血員40名作為C組。比較A、B組患者的手術(shù)時(shí)間、住院時(shí)間、輸血量、搶救成功率、各項(xiàng)并發(fā)癥發(fā)生率,同時(shí)比較A、B組患者術(shù)后T淋巴細(xì)胞水平變化并觀察其與C組成員血中各T細(xì)胞水平的對(duì)比情況。結(jié)果B組的手術(shù)時(shí)間、住院時(shí)間、輸血量均明顯低于A組(P0.01),B組的搶救成功率明顯高于A組(χ~2=4.13,P=0.04);B組的總并發(fā)癥發(fā)生率(4.44%)明顯低于A組(25.00%)(χ~2=7.38,P0.01);A、B組患者術(shù)后15 d和30 d的CD3~+、CD4~+、CD8~+、CD4~+/CD8~+水平均明顯低于C組(P0.05),B組術(shù)后15 d和30 d的CD3~+、CD4~+、CD4~+/CD8~+水平均明顯高于A組(P0.01)。結(jié)論脾動(dòng)脈栓塞術(shù)治療外傷性脾破裂失血性休克的安全性高,操作簡(jiǎn)單,同時(shí)創(chuàng)傷較小,可減少并發(fā)癥的發(fā)生率,提高搶救成功率,且術(shù)后免疫功能恢復(fù)較快,值得在臨床推廣。
[Abstract]:Objective to study the clinical effect and immune function of different splenectomy for traumatic splenic rupture and hemorrhagic shock. Methods from January 2015 to February 2017, 85 patients with traumatic splenic rupture and hemorrhagic shock were treated with splenic repair (40 cases, group A) and splenic artery embolization (45 cases, group B). Another 40 healthy blood donors from the same period of time were selected as group C. The operative time, hospitalization time, blood transfusion volume, rescue success rate, and the incidence of complications in group A and B were compared, and the incidence of complications in group A and group B were compared at the same time. The levels of T lymphocytes in group B were compared with those in group C after operation. Results the operation time, hospitalization time and blood transfusion volume in group B were significantly lower than those in group A (P0.01). The success rate of rescue in group), B was significantly higher than that in group A (蠂 ~ 2-4.13, P < 0.05). The incidence of total complications in group B (4.44%) was significantly lower than that in group A (25.00%) (蠂 ~ 2 / 7.38, P0.01). The levels of CD3~, CD4~, CD8~, CD4~ / CD8~ in group A and B were significantly lower than those in group C on the 15th and 30th day after operation (P0.05). The levels of CD3~, CD4~, CD4~ / CD8~ in group), B were significantly higher than those in group A on the 15th and 30th day after operation (P0.01). Conclusion splenic artery embolization is safe and simple in the treatment of traumatic splenic rupture and hemorrhagic shock. At the same time, it can reduce the incidence of complications and improve the success rate of rescue, and the immune function can recover quickly after operation. It is worth popularizing in clinic.
【作者單位】： 安徽省銅陵市人民醫(yī)院急診外科;
【分類號(hào)】：R657.62

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