Analysis of the impact factor of treatment decision for patients with traumatic splenic injury
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摘要: 目的 探讨外伤性脾脏损伤治疗决策选择的影响因素。方法 回顾性分析2017年1月—2021年9月期间芜湖市第二人民医院收治的89例外伤性脾脏损伤患者的临床资料，根据治疗方式分为非手术治疗组和手术治疗组，对两组资料临床指标分别进行单因素和多因素统计学分析。结果 89例患者中，非手术治疗38例，手术治疗51例。非手术治疗组中，单纯保守治疗13例，脾动脉介入栓塞25例，均保脾治疗成功。手术治疗组中，51例均行脾脏切除手术。单因素分析结果显示血压、脉搏、血红蛋白、CT分级、腹腔出血量在两组间比较差异有统计学意义(P< 0.05)；多因素分析结果显示：血压OR=1.231，95%CI0.039~39.257，P>0.05；脉搏OR=2.077，95%CI0.188~22.987，P>0.05；血红蛋白OR=1.019，95%CI0.957~1.086，P>0.05；脾脏损伤CT分级OR=2.715，95%CI0.390~18.893，P>0.05；腹腔出血量OR=82.415，95%CI7.970~852.276，P< 0.05。结论 血压、脉搏、脾脏损伤CT分级与脾脏损伤治疗决策选择相关，腹腔出血量是其独立影响因素。Abstract: Objective To evaluate the impact factor of treatment decision for patients with traumatic splenic injury.Methods The clinical data of 89 patients with traumatic splenic injury admitted to the Second People's Hospital of Wuhu from Jan. 2017 to Sep. 2021 was retrospectively analyzed. According to treatment method, patients were divided into non-operative management group(NOM) and operative management group(OM). Univariate and multivariate analysis were performed between two groups.Results Eighty-nine patients were included in this study. In NOM group, 13 patients received pure conservative management and 25 patients underwent splenic artery embolization. All succeeded in spleen-preserving. In OM group, 51 patients underwent splenectomy. Univariate analysis showed that blood pressure, pulse, hemoglobin, CT grade and volume of abdominal hemorrhage were significant statistically different between two groups(P< 0.05). Multivariate analysis results were as follow: blood pressure(OR=1.231, 95%CI0.039-39.257,P>0.05), pulse(OR=2.077, 95%CI0.188-22.987,P>0.05), CT grade(OR=2.715, 95%CI0.390-18.893,P>0.05), volume of abdominal hemorrhage(OR=82.415, 95%CI7.970-852.276,P< 0.05).Conclusion Blood pressure, pulse and CT grade are related with treatment decision for patients with traumatic splenic injury. The volume of abdominal hemorrhage is an independent impact factor for it.
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Key words:
- splenic injury /
- treatment decision /
- impact factor
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表 1 两组患者资料的单因素分析
例，X±S 临床指标 非手术治疗组(38例) 手术治疗组(51例) χ2/t P 年龄/岁 47.2±18.2 48.7±14.8 0.420 >0.05 性别 男 25 34 0.007 >0.05 女 13 17 受伤原因 交通事故 23 33 摔倒 11 10 1.295 >0.05 高处坠落 4 8 血压/mmHga) 收缩压>90 37 28 19.939 < 0.05 收缩压≤90 1 23 脉搏/(次·min-1) < 100 32 23 14.110 < 0.05 ≥100 6 28 血红蛋白/(g·L-1) 125.8±20.5 116.6±18.1 -2.250 < 0.05 CT分级 1级 17 4 2级 17 22 22.557 < 0.05 3级 4 24 4级 0 1 腹腔出血量/mL 368.9±200.4 2249.0±834.5 -13.579 < 0.05 注：a)1 mmHg=0.133 kPa。 
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表 2 外伤性脾脏损伤治疗决策的多因素回归分析
因素 偏回归系数 标准误 Wald P OR 95%CI 血压 0.208 1.766 0.014 0.906 1.231 0.039~39.257 脉搏 0.731 1.227 0.355 0.551 2.077 0.188~22.987 血红蛋白 0.019 0.032 0.344 0.558 1.019 0.957~1.086 CT分级 0.999 0.990 1.019 0.313 2.715 0.390~18.893 出血量 4.412 1.192 13.700 < 0.001 82.415 7.970~852.276
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