骨盆骨折分类及治疗指南(二)

2011-08-15 00:00 来源:互联网 作者:
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This then gives the clinician the problem of working out as soon as possible which type of bleeding the patient has got. Clearly early recognition of arterial bleeding is desirable as in these cases angiography and embolisation should precede all other interventions.

这使得临床医师面临如何尽快查明患者出血类型的问题。显然,在这些病例中,早期识别动脉出血是必需的,动脉造影和栓塞术应早于所有其它干预措施。

Integrating CT into the resuscitation protocol therefore will not only serve to identify all of the patient’s injuries but can potentially differentiate the different types of pelvic bleed [18]. To achieve this both arterial and portal venous phase imaging should be employed where pelvic bleeding is suspected. Contrast extravasation identi?ed on both phases is likely to be arterial whereas extravasation seen only on the portal venous phase is consistent with venous bleeding.

将CT检查融入复苏草案将不仅有助于鉴别患者全部损伤,而且可能区分骨盆腔出血的类型[18]。要达到此目的,动脉期和门静脉期成像应选取骨盆可疑出血处。造影剂于两期均见外溢可能是动脉出血,反之,仅门静脉期外溢符合静脉出血的表现。

Therefore if the patient has multiple other injuries then the operating room may well be the preferred treatment option. The same applies to venous and cancellous pelvic bleeds. If however there are isolated arterial bleeds then clearly angiography, where available, if preferable.

因此,如果患者合并多重其它损伤,手术治疗可能是首选。这同样适用于骨盆腔的静脉和松质骨出血。然而,如果合并单独动脉出血,如果具备条件,明显应行血管造影检查。

A new management algorithm is proposed for pelvic fractures incorporating early CT (Table 1).

一项新的诊疗规则建议,骨盆骨折早期行CT检查(表1)。

表1:骨盆骨折诊疗基本规则。注意:如果患者存在其它危及生命的损伤需紧急处置,该措施可能不适用。

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