【摘要】 目的 评估脾动脉栓塞治疗创伤性脾破裂临床效果，探讨影响治疗结果及出现并发症的危险因素。方法回顾性分析2015年1月1日至2022年1月1日台州市立医院、厦门长庚医院收治的63例创伤闭合性脾破裂并且进行脾动脉栓塞治疗患者的临床资料，分析其临床特征及影响预后的因素并建立预测模型。结果 63例创伤闭合性脾破裂并且进行脾动脉栓塞治疗的病例，抢救成功60例、死亡2例、介入术后转开腹1例，成功率为95.24%。治疗过程出现并发症15例。经ROC曲线分析，当创伤严重评分（ISS）≥27.5分时，其对并发症诊断最为敏感，此时敏感度达到46.70%，特异度达到77.10%；单因素分析，血红蛋白（Hb）、活化部分凝血活酶时间（APTT）、脾损伤分级（AAST）在并发症的发生率存在显著差异（P <0.05）；多因素分析，APTT和Hb是影响并发症发生率的独立因素（P <0.05）；应用nomogram预测模型，APTT>36 s出现并发症的可能性是≤36 s的17.936倍，Hb[130,175)g/L的并发症风险仅仅是Hb[70,90)g/L的6%。结论 ISS≥27.5分时，其对并发症诊断最为敏感；Hb、APTT、AAST是脾动脉栓塞治疗创伤性脾破裂出现并发症的影响因素，且APTT和Hb水平是影响并发症发生的独立因素。更多还原

【Abstract】 Objective To evaluate the clinical efficacy of splenic artery embolization in the treatment of traumatic splenic rupture, and explore the risk factors that affect treatment outcomes and complications.Methods Retrospective analysis was conducted on the clinical data of 63 cases of traumatic closed splenic rupture treated with splenic artery embolization at Taizhou Municipal Hospital and Xiamen Chang Gung Hospital from January 1, 2015 to January 1, 2022, with their clinical characteristics and factors affecting prognosis analyzed, and predictive models established. Results Among 63 cases of traumatic closed splenic rupture treated with splenic artery embolization, 60 cases were successfully rescued, 2 cases died, and 1 case underwent laparotomy after interventional surgery, with a success rate of 95.24%. Complications occurred in 15 cases during the treatment process. According to ROC curve analysis, when the injury severity score(ISS) was ≥ 27.5 points, it was most sensitive to the diagnosis of complications, with a sensitivity of 46.70% and a specificity of 77.10%; univariate analysis showed significant differences in the incidence of complications among hemoglobin(Hb), activated partial thromboplastin time(APTT), and American association for the surgery of trauma(AAST) splenic injury scale(P < 0.05); multivariate analysis showed that APTT and Hb were independent factors affecting the incidence of complications(P < 0.05); the nomogram prediction model showed that the likelihood of complications occurring in APTT > 36 s was 17.936-fold higher than that occurring in APTT ≤ 36 s, and the risk of complications in Hb [130, 175) g/L was only 6%of that in Hb [70, 90) g/L. Conclusion When ISS is ≥ 27.5 points, it is the most sensitive for the diagnosis of complications. Hb, APTT, and AAST are the influencing factors for the occurrence of complications in splenic artery embolization treatment of traumatic splenic rupture, and APTT and Hb levels are independent factors affecting the occurrence of complications.更多还原