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骨盆骨折相关的血液瘤 - 紧急治疗和控制出血

S Möller¹, D Dillinger², S Hempe²

¹BG Trauma Hospital , Frankfurt am Main, Germany. stefanie.weber.goettingen@gmail.com.

European journal of trauma and emergency surgery : official publication of the European Trauma Society

|March 9, 2026

概括

不稳定的骨盆骨折带来严重出血的风险. 盆腔血管损伤评分 (P-VIS) 和CT体积测量有助于早期发现盆腔血管损伤 (PVI),指导针对性干预,提高创伤患者的生存率.

科学领域:

创伤外科手术创伤外科
血管放射学血管放射学
紧急医疗紧急医疗

背景情况:

不稳定的骨盆骨折与来自动脉,静脉和骨来源的危及生命的出血有关.
及时识别出血源对于有效的创伤管理至关重要.
评估盆腔血管损伤 (PVI) 的现有方法需要改进,以便快速临床应用.

研究的目的:

评估盆腔血管损伤评分 (P-VIS) 和基于CT的体积评估 (Kothari的方法) 对严重受伤患者PVI的早期检测和分类的实用性.
为了比较不同出血控制策略在患有不稳定的骨盆骨折的患者中的有效性.

主要方法:

一项多中心的回顾性研究包括了患有Tile类型B或C骨盆环损伤,高ISS和血液动力学不稳定的成年患者.
CT扫描用于血液瘤体积估计 (Kothari的公式) 和验证.
盆腔血管损伤得分 (P-VIS) 应用在医院前或周围,以预测PVI的可能性.
分析了临床数据,包括出血源,干预措施和死亡率.

主要成果:

在229名患者中,56名患有盆腔出血 (中位数为233毫升);1.7%患有显著出血 (≥500毫升).
动脉出血 (26.8%) 与高输血需求和死亡率有很强的相关性.
P-VIS ≥6显著增加了血管损伤的可能性;动脉出血,ISS和凝血病预测死亡率.
死亡率为30.3%,在动脉损伤和严重休克患者中更高.

结论:

大多数盆腔出血是静脉或骨质出血,但动脉损伤虽然不太常见,但与高死亡率有关.
科塔里的方法提供了快速的体积估计,P-VIS有助于早期对PVI进行分拣.
将机械稳定与有针对性的出血控制 (静脉包装,动脉栓塞) 结合起来,可以改善不稳定的骨盆骨折的结果.

关键词:

控制出血,控制出血的时间.发生出血发生出血骨盆创伤是因为骨盆的创伤.创伤管理创伤管理测量体积的方法

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