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中华普外科手术学杂志(电子版) ›› 2022, Vol. 16 ›› Issue (01) : 63 -66. doi: 10.3877/cma.j.issn.1674-3946.2022.01.019

论著

腹部闭合性外伤与开放性外伤的围手术期临床特征分析
邓欢1, 曹博1, 崔昊2, 刘贵宾2, 宋立强2, 李航航1, 赵瑞阳1, 陈凛1, 卫勃1,()   
  1. 1. 100853 北京,解放军医学院;100853 北京,解放军总医院第一医学中心普通外科医学部
    2. 100853 北京,解放军医学院
  • 收稿日期:2021-06-10 出版日期:2022-02-26
  • 通信作者: 卫勃

Analysis of perioperative clinical characteristics of blunt abdominal trauma and open trauma

Huan Deng1, Bo Cao1, Hao Cui2, Guibin Liu2, Liqiang Song2, HangHang Li1, Ruiyang Zhao1, Lin Chen1, Bo Wei1,()   

  1. 1. Medical School of Chinese PLA, Beijing 100853, China; Department of General Surgery, the First Medical center Chinese PLA General Hospital, Beijing 100853, China
    2. Medical School of Chinese PLA, Beijing 100853, China
  • Received:2021-06-10 Published:2022-02-26
  • Corresponding author: Bo Wei
  • Supported by:
    National Natural Science Foundation of China(82073192); National Key Research and Development Project of China(2019YFB1311505)
引用本文:

邓欢, 曹博, 崔昊, 刘贵宾, 宋立强, 李航航, 赵瑞阳, 陈凛, 卫勃. 腹部闭合性外伤与开放性外伤的围手术期临床特征分析[J]. 中华普外科手术学杂志(电子版), 2022, 16(01): 63-66.

Huan Deng, Bo Cao, Hao Cui, Guibin Liu, Liqiang Song, HangHang Li, Ruiyang Zhao, Lin Chen, Bo Wei. Analysis of perioperative clinical characteristics of blunt abdominal trauma and open trauma[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(01): 63-66.

目的

分析腹部闭合性外伤与开放性外伤患者围手术期的临床特征,比较两者在外科手术救治过程中的差别。

方法

回顾性分析2011年1月至2017年12月87例腹部外伤手术患者的临床资料,根据受伤后有无腹部开放性伤口将患者分为闭合组(n=41)和开放组(n=46)。使用统计学软件SPSS 26.0进行统计学分析,正态分布的计量资料以平均值±标准差(

xˉ
±s)表示,组间比较采用t检验。非正态分布的定量资料以中位数M(四分位间距IQR)表示,组间比较采用秩和检验。以P<0.05为差异具有统计学意义。

结果

致伤因素中,闭合组主要致伤原因为车祸伤,占46.3%,开放组主要致伤原因为刀刺伤,占56.5%。多发伤在闭合组和开放组中分别占58.5%、23.9%。闭合组与开放组相比,术前中性粒细胞与淋巴细胞之比(3.31 vs. 2.35)、住院时间(12 d vs. 9 d)、术中出血量(650 ml vs. 400 ml)、伤口乙级愈合(34例 vs. 28例)、术中输血(38例 vs. 33例)、肠道-腹壁造瘘(25例 vs. 37例)、术后并发症≤Ⅱ级(23例 vs. 36例),差异均具有统计学意义(P<0.05)。

结论

腹部闭合性外伤与开放性外伤具有不同的临床特征,总体而言,闭合性损伤患者病情较重,手术难度大,术后并发症较严重,围手术期管理更复杂,闭合性外伤应当采取专门的诊疗方案。

Objective

To analyze the perioperative clinical characteristics of patients with blunt abdominal trauma and open trauma,and to compare the differences during the clinical treatment process.

Methods

A retrospective analysis method was used to collect clinical data of 87 patients with abdominal trauma between January 2011 and December 2017. Patients were divided into blunt trauma group(n=41 cases)and open trauma group(n=46 cases)according to whether there were open abdominal wounds. Statistical software SPSS26.0 was used for data analysis. Measurement data of normal distribution was expressed as(

xˉ
±s),and t-test was used for comparison between groups. Non-normally distribution quantitative data are showed by the median(interquartile range IQR),and the rank sum test was used for comparison between groups. P<0.05 was considered as statistically significant difference.

Results

Among the injury factors,the main cause of injury in the blunt group was car accident injury,accounting for 46.3%,and the main cause of injury in the open group was knife stabbing,accounting for 56.5%. Multiple injuries were 58.5% in the blunt group and 23.9% in the open group,respectively. Compared with the open group,the ratio of neutrophils to lymphocytes before operation(3.31 vs. 2.35),hospitalization time(12 d vs.9 d),intraoperative blood loss(650 ml vs. 400 ml),and grade Ⅱ wound healing(34 cases vs. 28 cases),intraoperative blood transfusion(38 cases vs. 33 cases),intestinal-abdominal wall fistula(25 cases vs. 37 cases),postoperative complications ≤grade Ⅱ(23 cases vs. 36 cases),the differences were statistically significant(P<0.05).

Conclusion

Blunt abdominal trauma and open trauma have different clinical characteristics. In general,patients with blunt trauma are more severely injury,difficult to surgery,more serious postoperative complications,and more complicated during perioperative management. The diagnosis and treatment strategy of blunt trauma should be prepared differently.

表1 87例腹部外伤两组患者围手术期一般资料比较[(
xˉ
±s),例]
表2 87例腹部外伤患者两组围手术期临床特征比较(例)
表3 87例腹部外伤患者两组围手术期整体特征的对比分析[M(IQR)]
图1 两例腹部外伤患者的CT a和b为一例车祸导致的闭合性腹部外伤患者CT,显示肝周积液和肠壁水肿;c和d为一例经脐上刀刺伤导致的开放性外伤患者CT,显示穿透胃壁和损伤胰腺。
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