摘要
目的探讨超声造影对腹部实质脏器创伤程度进行快速评估的价值及与临床治疗方案相关的因素分析。方法应用超声造影观察52例腹部实质脏器创伤患者，根据美国创伤外科协会（AAST）标准判断创伤程度，观察腹腔积液变化、活动性出血、累及血管级别等情况，建立快速评估创伤严重程度的方法，并研究不同程度创伤与手术和保守治疗的相关性。结果52例患者共71个不同程度的实质脏器破裂，复合伤占82．7％（43／52）。其中37个I～Ⅲ级较低级别创伤，34个Ⅳ～V级严重创伤。超声造影观察伴活动性出血的病灶占76．1％（54／71），其中伴快速出血的7个创伤灶，腹腔积液在30min内明显增加（P〈0．05）。伴活动性出血的50个创伤灶中，手术治疗的比例为24．0％（12／50），保守治疗的比例为76．0％（38／50）。创伤累及二级以下血管的病灶，I～Ⅲ级创伤占97．3％（36／37），IV～V级创伤占61．8％（21／34）；创伤灶累及二级以上血管的病灶，手术治疗占23．1％（12／52），保守治疗占44．2％（23／52）。结论根据病灶范围判断创伤程度的AAST标准不能全面反映创伤的严重程度，它不仅与创伤灶的范围有关，还与创伤累及的血管级别、是否伴发活动性出血、出血的速度，以及腹腔积液量等因素有关。
Objective To quickly evaluate the traumatic degree of abdominal solid-organs using contrast-enhanced ultrasonography （CEUS） and analysis on related factors with clinical treatment. Methods 52 patients with abdominal traumatic were observed by CEUS, and the traumatic degree was judged according to American Association for the Surgery of Trauma （AAST）. The change of peritoneal fluid was observed with ultrasonography, and active bleeding and involve adjacent vessels their branches were observed with CEUS. In this way, a method of quickly evaluate the traumatic degree was established, and the correlation between indifferent grade trauma and appropriate interventions that include surgical and conservative treatment was studied. Results 52 patients with 71 lesions, compound injuries accounted for 82.7% （43/52）. Among them,37 lesions were I - Ⅲgrade trauma,34 lesions were severe trauma of IV - V grade. The lesions complicated with active bleeding were 76.1% （54/71）. The amount of peritoneal fluid was increased significantly within 30 min （ P d0.05） in traumatic lesions with rapid bleeding. Among of 50 lesions associated with active bleeding, the surgical treatment was 24.0% （12/50）, the conservative treatment was 76.0% （38/50）. Among of trauma lesions involving the two following vessels, I -Ⅲ grade was 97.3% （36/37）, IV - V grade was 61.8% （21/34）. Trauma involvement above level 2 focal blood vessels,surgical treatment accounted for 23.1% （12/52）, conservative treatment accounted for 44. 2% （23/52）. Conclusions The severity of the trauma can not be a comprehensive response by AAST,becauce it is not only related to the scope of the traumatic lesions, vascular level, also involved with the trauma associated with active bleeding, bleeding speed and amount of peritoneal effusion and other factors.
出处
《中华超声影像学杂志》
CSCD
北大核心
2012年第9期779-783,共5页
Chinese Journal of Ultrasonography
基金
全军医药卫生科研基金资助项目（082036）
关键词
超声检查
微气泡
腹部损伤
Ultrasonography
Microbubbles Abdominal injuries
