Trulas liesas traumas ārstēšanas taktika Paula Stradiņa klīniskās universitātes slimnīcas Ķirurģijas klīnikā
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Date
2020
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Trauma ir vadošais nāves iemesls cilvēkiem jaunākiem par 45 gadiem. Trulas abdominālas traumas gadījumā liesa ir visbiežāk ievainotais orgāns. Pētījuma mērķis bija noskaidrot noteicošos kritērijus trulas liesas traumas ārstēšanas taktikas izvēlē.
Retrospektīvs pētījums veikts Paula Stradiņa Klīniskās universitātes slimnīcas Ķirurģijas klīnikā laika posmā no 2012. līdz 2019. gadam. Dati reģistrēti no arhīvā pieejamām medicīniskajām kartēm. Pacienti atlasīti pēc SSK–10 diagnozes koda S36.0 – liesas ievainojums. Tā smaguma pakāpes noteikšanai izmantots American Association for the Surgery of Trauma Splenic Injury Scale. Dati ievākti un analizēti, izmantojot MS Excel 2010 un IBS SPSS Statistics 22.0. Pētījums apstiprināts Rīgas Stradiņa universitātes Pētījumu ētikas komitejā.
Pētījumā iekļauti 54 pacienti, 13 (24%) sievietes, 41 (76%) vīrietis. Pacientu mediānais vecums 37 gadi un laika intervāls kopš traumas sākuma 6 stundas. Ārstēšanas taktikā operatīva terapija pielietota 36 (67%) gadījumos, bet konservatīva – 18 (33%), no kuriem liesas artērijas angioembolizācija veikta 3 (5%) pacientiem. Pētījumā pierādīts, ka, palielinoties liesas ievainojuma pakāpei, biežāk pielietota ķirurģiska un mazāk – konservatīva terapija. Tomēr statistiski būtiskas atšķirības terapijas izvēlē nebija starp II un III pakāpi. Pacientu vitālie rādītāji, laboratorie un radioloģiskie izmeklējumi statistiski būtiski atšķīrās starp terapijas grupām. No 54 pacientiem Neatliekamās medicīnas centra etapā 4 slimniekiem reģistrēja nestabilu hemodinamiku. Visiem šiem pacientiem pielietoja ķirurģisku ārstēšanu. Hemoglobīna līmenis, eritrocītu skaits, aktīva ekstravazācija un hemoperitonija klātbūtne datortomogrāfijas izmeklējumā statistiski būtiski atšķīrās starp konservatīvo un ķirurģisko grupu.
Galvenie kritēriji starp ķiurģiskās un konservatīvās terapijas izvēli ir saistīti ar aktīvu asiņošanu. Precīzāki kritēriji terapijas izvēlei nepieciešami pacientiem ar II un III liesas bojājuma pakāpi.
Trauma is the leading cause of death in people younger than 45 years. In case of blunt abdominal trauma spleen is the most frequently injured organ. The aim of this study was to define criteria for treatment tactics in case of blunt splenic injury. A retrospective study was conducted at Pauls Stradiņš Clinical University Hospital, Department of Surgery from 2012 up to 2019. The data was accessed and registered from patients’ medical records. Patients selected by ICD – 10 code S36.0 – Injury of spleen. The severity of injury stated according to American Association for the Surgery of Trauma Splenic Injury Scale. The data was regisered and analyzed using MS Excel 2010 and IBS SPSS Statistics 22.0. The study approved by Ethical committee of Rīga Stradiņš University. Overall 54 patients were included, 13 (24%) women and 41 (76%) men. The median age of patients was 37 years and median time since injury occured was 6 hours. OM (operative management) was used in 36 (67%) patients and NOM (non-operative management) – in 18 (33%) patients, and 3 (5%) of them had splenic artery angioembolisation. The study has shown that in higher grade injuries NOM is used less and OM – more frequently. However, there were no statistical differences between treatment tactics in II and III grade injuries. Other factors as patients’ vital signs, laboratory and radiological findings had statistical differences between OM and NOM. Out of 54 patients in Emergency department 4 had unstable haemodinamics. OM was used to all of them. Hemoglobin level, red blood cell count, active extravasation and haemoperitoneum detected by computed tomography had statistical differences between OM and NOM. Defining criteria when choosing between OM and NOM is associated with active bleeding. More accurate criteria are needed when choosing treatment in case of II and III splenic injury degree.
Trauma is the leading cause of death in people younger than 45 years. In case of blunt abdominal trauma spleen is the most frequently injured organ. The aim of this study was to define criteria for treatment tactics in case of blunt splenic injury. A retrospective study was conducted at Pauls Stradiņš Clinical University Hospital, Department of Surgery from 2012 up to 2019. The data was accessed and registered from patients’ medical records. Patients selected by ICD – 10 code S36.0 – Injury of spleen. The severity of injury stated according to American Association for the Surgery of Trauma Splenic Injury Scale. The data was regisered and analyzed using MS Excel 2010 and IBS SPSS Statistics 22.0. The study approved by Ethical committee of Rīga Stradiņš University. Overall 54 patients were included, 13 (24%) women and 41 (76%) men. The median age of patients was 37 years and median time since injury occured was 6 hours. OM (operative management) was used in 36 (67%) patients and NOM (non-operative management) – in 18 (33%) patients, and 3 (5%) of them had splenic artery angioembolisation. The study has shown that in higher grade injuries NOM is used less and OM – more frequently. However, there were no statistical differences between treatment tactics in II and III grade injuries. Other factors as patients’ vital signs, laboratory and radiological findings had statistical differences between OM and NOM. Out of 54 patients in Emergency department 4 had unstable haemodinamics. OM was used to all of them. Hemoglobin level, red blood cell count, active extravasation and haemoperitoneum detected by computed tomography had statistical differences between OM and NOM. Defining criteria when choosing between OM and NOM is associated with active bleeding. More accurate criteria are needed when choosing treatment in case of II and III splenic injury degree.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Trula abdomināla trauma; liesas ievainojums, Blunt abdominal trauma; splenic injury