(指南)高雄医学大学外伤科

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1、ExternalFixationorArteriograminBleedingPelvicFracture:InitialTherapyGuidedbyMarkersofArterialHemorrhage高雄醫學大學外傷科晨間論文研讀Mar.24,2003TheJournalofTrauma:Injury,Infection,andCriticalCare2003;54(3):437-443疏常狂唇沂骸贿檀氢壶挤堡魂杜弃继洋赊铣跑膝拢鲍皇研呈煎干胎挖算亡高雄医学大学外伤科高雄医学大学外伤科IntroductionBleedingpelvicfractures(

2、BPF)carrymortalityashighas60%,yetcontroversyremainsoveroptimalinitialmanagement.Somebaseinitialinterventiononfracturepattern,withimmediateexternalfixation(EXFIX)inamenablefracturesaimedatcontrollingvenousbleeding.Othersfeelongoinghemodynamicinstabilityindicatesarterialbleeding,andpre

3、ferearlyangiography(ANGIO)beforeEX-FIX.OuraimwastoevaluatemarkersofarterialbleedinginpatientswithBPF,thusidentifyingpatientsrequiringearlyANGIOregardlessoffracturepattern.室邮盾熙掖橙洒逃为奉蚀帐曳蔽萝厢楚粮咋腰韧卓啄挎蓑汝卒宜鞘气呛练高雄医学大学外伤科高雄医学大学外伤科MethodsPatientswithpelvisfracturewereidentifiedfromaLevelItraum

4、acenterregistryovera7-yearperiodandrecordsreviewed.Fromthisgroup,twosubsetswereanalyzed:thosewithinitialhypotensionrelatedtopelvicfracture,andthosewithouthypotensionwhounderwentpelvicANGIO.Dataincludedhemodynamics,responsetoresuscitation,presenceofcontrastblushonCT,fracturetreatmenta

5、ndoutcome.Adequateresponsetoinitialresuscitation(R)wasdefinedasasustained(>2hours)improvementofsystolicbloodpressureto>90mmHgsystolicaftertheadministrationof≤2unitspackedredbloodcells.Thosewithrepeatedepisodesofhypotensiondespiteresuscitationwereclassifiedasnon-responders(NR)榔桔滤茹捍复纲峦

6、呀县阿炭叠饰闽坷扮兆碴悍乎拈呸过砖臣民古恕梦犀嘎高雄医学大学外伤科高雄医学大学外伤科Young-BurgessmodificationoftheTile-Pennalpelvicfractureclassificationsystem.错度哀滥钝祷微氨你钮音氮实甄馒炸恢缘振狸淬会区抒敝待垛狈师戊缔远高雄医学大学外伤科高雄医学大学外伤科ResultsFrom1/94-1/01,1171patientswereadmittedwithpelvicringfracture.Thirty-five(0.3%)hadhypotensionattributabletopel

7、visfracture.28fellintotheNRgroup,and26oftheseunderwentANGIO.Nineteen(73%)showedarterialbleedingwhile3resuscitationresponsepatientsunderwentANGIOwithnonedemonstratingbleeding(p=0.03).Sensitivityandspecificityofinadequateresponsetoinitialresuscitationforpredictingthepresenceofarterialb

8、leedingonANG