不同脾保留术对外伤性脾破裂失血性休克患者免疫功能的影响

发布时间：2019-03-16 14:32

【摘要】：目的研究不同脾保留术治疗外伤性脾破裂失血性休克的临床效果和对免疫功能影响。方法研究对象选取我院2015年1月至2017年2月间收治的外伤性脾破裂失血性休克患者85例,分别采用脾修补手术(40例,A组)和脾动脉栓塞术治疗(45例,B组),另选取同时间段的健康献血员40名作为C组。比较A、B组患者的手术时间、住院时间、输血量、抢救成功率、各项并发症发生率,同时比较A、B组患者术后T淋巴细胞水平变化并观察其与C组成员血中各T细胞水平的对比情况。结果B组的手术时间、住院时间、输血量均明显低于A组(P0.01),B组的抢救成功率明显高于A组(χ~2=4.13,P=0.04);B组的总并发症发生率(4.44%)明显低于A组(25.00%)(χ~2=7.38,P0.01);A、B组患者术后15 d和30 d的CD3~+、CD4~+、CD8~+、CD4~+/CD8~+水平均明显低于C组(P0.05),B组术后15 d和30 d的CD3~+、CD4~+、CD4~+/CD8~+水平均明显高于A组(P0.01)。结论脾动脉栓塞术治疗外伤性脾破裂失血性休克的安全性高,操作简单,同时创伤较小,可减少并发症的发生率,提高抢救成功率,且术后免疫功能恢复较快,值得在临床推广。
[Abstract]:Objective to study the clinical effect and immune function of different splenectomy for traumatic splenic rupture and hemorrhagic shock. Methods from January 2015 to February 2017, 85 patients with traumatic splenic rupture and hemorrhagic shock were treated with splenic repair (40 cases, group A) and splenic artery embolization (45 cases, group B). Another 40 healthy blood donors from the same period of time were selected as group C. The operative time, hospitalization time, blood transfusion volume, rescue success rate, and the incidence of complications in group A and B were compared, and the incidence of complications in group A and group B were compared at the same time. The levels of T lymphocytes in group B were compared with those in group C after operation. Results the operation time, hospitalization time and blood transfusion volume in group B were significantly lower than those in group A (P0.01). The success rate of rescue in group), B was significantly higher than that in group A (蠂 ~ 2-4.13, P < 0.05). The incidence of total complications in group B (4.44%) was significantly lower than that in group A (25.00%) (蠂 ~ 2 / 7.38, P0.01). The levels of CD3~, CD4~, CD8~, CD4~ / CD8~ in group A and B were significantly lower than those in group C on the 15th and 30th day after operation (P0.05). The levels of CD3~, CD4~, CD4~ / CD8~ in group), B were significantly higher than those in group A on the 15th and 30th day after operation (P0.01). Conclusion splenic artery embolization is safe and simple in the treatment of traumatic splenic rupture and hemorrhagic shock. At the same time, it can reduce the incidence of complications and improve the success rate of rescue, and the immune function can recover quickly after operation. It is worth popularizing in clinic.
【作者单位】：安徽省铜陵市人民医院急诊外科;
【分类号】：R657.62

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