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不同血管栓塞技术和材料用于血液动力学不稳定的骨盆骨折的临床结果:重叠权衡研究
Hui Li1,2, Guangbin Huang2, Yunfeng Yi3
1Department of Emergency Medicine, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
World journal of surgery
|October 4, 2025
概括
与选择性栓塞 (SE) 相比,用于血液动力学不稳定的骨盆骨折 (HUPF) 的非选择性栓塞 (NSE) 减少了红细胞输血和加快了出血控制. 然而,NSE并没有改善生存率,需要对最佳技术和材料进行进一步的研究.
科学领域:
- 干预性放射学 干预性放射学
- 创伤外科 手术 创伤外科
- 血管外科 血管外科
背景情况:
- 内动脉栓塞 (IIAE) 对于在血液动力学不稳定的骨盆骨折 (HUPF) 中管理出血至关重要.
- 最佳的IIAE技术 (非选择性与选择性栓塞) 和栓塞材料仍然是争论的主题.
- 本研究将非选择性栓塞 (NSE) 与选择性栓塞 (SE) 对HUPF的疗效和安全性进行比较,并对栓塞材料进行二次分析.
研究的目的:
- 为了比较NSE和SE技术在HUPF患者中的有效性和安全性.
- 评估不同栓塞材料对接受IIAE的HUPF患者临床结果的影响.
- 为了确定NSE与SE相比,在输血要求,手术时间或并发症率方面是否具有优势.
主要方法:
- 一个多中心的回顾性研究296名患者 (年龄≥16) 的HUPF接受IIAE.
- 患者被分为NSE或SE组,倾向性得分重叠权重 (PSOW) 和倾向性得分匹配 (PSM) 进行分析.
- 关键结局包括24小时红细胞输血量,血管栓塞 (AE) 持续时间,并发症,死亡率和感染率.
主要成果:
- 在PSOW后,与SE相比,NSE与显著较低的24小时红细胞输血量 (2.00对4.00单位) 和较短的AE持续时间 (65对80分钟) 相联系.
- 虽然最初的PSOW表明NSE组的深静脉血栓和尿路感染率较高,但PSM分析显示没有显著差异.
- 亚组分析表明,与卷轴相比,使用凝海绵 (GS) 与更高的输血量和更长的AE持续时间有关,特别是肺部和切口/针管感染的增加.
结论:
- 非选择性栓塞 (NSE) 在HUPF患者中显示了减少红细胞输血需求和更快的出血控制,尽管这并没有转化为更好的生存率.
- 关于NSE对特定并发症风险的比较影响仍然没有确定性.
- 在子组分析中,卷轴与凝海绵 (GS) 相比,似乎与更少的并发症有关,因此需要进一步调查最佳栓塞材料.
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