Journal of Trauma and Injury

  • 제22권2호
  • /
  • Pages.193-198
  • /
  • 2009
  • /
  • 2799-4317(pISSN)
  • /
  • 2287-1683(eISSN)
대한외상학회 (The Korean Society of Traumatology)
권호 표지

외상후 복부 다발성 고형장기 손상

Multiple Intraabdominal Solid Organ Injuries after Blunt Trauma

  • 박형도 (울산대학교병원 응급의학과) ;
  • 김선휴 (울산대학교병원 응급의학과) ;
  • 이종화 (울산대학교병원 영상의학과) ;
  • 홍정석 (울산대학교병원 응급의학과) ;
  • 홍은석 (울산대학교병원 응급의학과)
  • Park, Hyung Do (Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Kim, Sun Hyu (Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Lee, Jong Hwa (Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Hong, Jung Seok (Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Hong, Eun Seog (Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine)
  • 투고 : 2009.08.14
  • 심사 : 2009.09.25
  • 발행 : 2009.12.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: This study evaluated the characteristics and the prognosis of multiple intraabdominal solid organ injuries, including those to the liver, spleen, and kidney, after blunt trauma. Methods: From January 2001 to March 2009, 39 patients with multiple intraabdominal solid organ injuries, which had been confirmed by contrast-enhanced computed tomography after blunt trauma, were included in this retrospective study. The injury severity score (ISS), abbreviated injury scale (AIS), revised trauma score (RTS), American Association for the Surgery of Trauma (AAST) injury grade of solid organs, initial hemodynamic status, blood gas analysis, blood transfusion, and the mortality were the main outcome measurements. Results: Injured groups were classified into liver/kidney (n=17), liver/spleen (n=4), spleen/kidney (n=13), and liver/kidney/spleen (n=5) groups. Patients were older in the liver/kidney group than in the liver/kidney/spleen group (43 vs 18 years, p=0.023). The initial systolic blood pressures tended to be lower in the liver/kidney group than in the other groups (84 vs 105, 112, and 114 mmHg, p=0.087). The amounts of 24-hour packed RBC transfusion were 32 units in the liver/kidney group and 4 units in the liver/kidney/spleen group, but the difference was not statistically significant. Differences were found in neither the RTS, ISS, and AIS for head, chest, abdominal, and pelvic injuries nor the AAST injury grade for solid organ, but injuries to the chest were more severe in the liver/spleen group than in the spleen/kidney group (AIS 4.0 vs 2.8, p=0.028). Conservative treatment was the most frequent applied treatment in all groups. There were 6 mortalities : 3 due to hypovolemia, 2 to sepsis, and 1 to brain injury. Mortalities occurred only in the liver/kidney group. Conclusion: Patients who had intraabdominal solid organ injuries of the liver and the kidney simultaneously, tended to be transfused more at an early time after trauma, to have lower initial systolic blood pressures, and to have a higher mortality.

키워드

참고문헌

  1. Abdominal Trauma. In: American College of Surgeons Committee on Trauma. Advanced Trauma Life Support. 7th ed. American College of Surgeons 2007:131-45
  2. Healey MA, Simons RK, Winchell RJ, Gosink BB, Casola G, Steele JT, et al: A prospective evaluation of abdominal ultrasound in blunt trauma: Is it useful? J Trauma 1996;40:875-83 https://doi.org/10.1097/00005373-199606000-00004
  3. Kirkpatrick AW, Sirois M, Laupland KB, Goldstein L, Brown DR, Simons RK, et al: Prospective evaluation of hand-held focused abdominal sonography for trauma(FAST) in blunt abdominal trauma. Can J Sug, 2005;48:453-60
  4. Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR. Organ injury scaling: spleen and liver (1994 revision). J Trauma. 1995;38:323-4
  5. Hamilton JD, Kumaravel M, Censullo ML, Cohen AM, Kievlan DS, West OC. Multidetector CT evaluation of active extravasation in blunt abdominal and pelvic trauma patients. Radiographics 2008;28:1603-16 https://doi.org/10.1148/rg.286085522
  6. Maturen KE, Adusumilli S, Blane CE, Arbabi S, Williams DM, Fitzgerald JT, et al. Contrast-enhanced CT accurately detects hemorrhage in torso trauma: direct comparison with angiography. J Trauma 2007;62:740-5 https://doi.org/10.1097/01.ta.0000235508.11442.a8
  7. Baik JJ, Kim JI, Choi SH, Choi YC, Jun SY, Lee JH, et al: Nonoperative Management of Blunt Liver Trauma. J Korean Soc Traumatol 2005;18:161-71
  8. Cha SH, Jung YS, Won JH, Kim WW, Wang HJ, Kim MW, et al: Use of a Postpoerative Hepatic Arterial Embolization in Patients with Postoperative Bleeding due to Severe Hepatic Injuries. J Korean Soc Traumatol 2006;19:59-66
  9. Kim HJ, Kim HS, Seo KW, Ju JK, Ryu SY, Kim JC, et al: Analysis of the Prognostic Factors for Abdominal Trauma. J Korean Soc Traumatol 2007;20:12-8
  10. Heuer M, Taeger G, Kaiser GM, Nast-Kolb D, Kuehne CA, Ruchholtz S, et al. Prognostic factors of liver injury in polytraumatic patients. Results from 895 severe abdominal trauma cases. J Gastrointestin Liver Dis 2009;18):197-203
  11. Schnuriger B, Inderbitzin D, Schafer M, Kickuth R, Exadaktylos A, Candinas D. Concomitant injuries are an important determinant of outcome of high-grade blunt hepatic trauma. Br J Surg 2009;96:104-10 https://doi.org/10.1002/bjs.6439
  12. Janzen DL, Zwirewich CV, Breen DJ, Nagy A. Diagnostic accuracy of helical CT for detection of blunt bowel and mesenteric injuries. Clin Radiol 1998;53:193-7 https://doi.org/10.1016/S0009-9260(98)80099-8
  13. Holden A. Abdomen-Interventions for solid organ injury. Injury 2008;39:1275-89 https://doi.org/10.1016/j.injury.2008.04.019
  14. Pr$\hat{e}$tre R, Mentha G, Huber O, Meyer P, Vogel J, Rohner A. Hepatic trauma: risk factors influencing outcome. Br J Surg 1988;75:520-4 https://doi.org/10.1002/bjs.1800750606
  15. Fang JF, Chen RJ, Lin BC, Hsu YB, Kao JL, Chen MF. Blunt hepatic injury: minimal intervention is the policy of treatment. J Trauma 2000;49:722-8 https://doi.org/10.1097/00005373-200010000-00022
  16. Malhotra AK, Fabian TC, Croce MA, Gavin TJ, Kudsk KA, Minard G, et al. Blunt hepatic injury: a paradigm shift from operative to nonoperative management in the 1990s. Ann Surg 2000;231:804-13 https://doi.org/10.1097/00000658-200006000-00004
  17. Cosgriff N, Moore EE, Sauaia A, Kenny-Moynihan M, Burch JM, Galloway B. Predicting life-threatening coagulopathy in the massively transfused trauma patient: hypothermia and acidoses revisited. J Trauma 1997;42:857-61 https://doi.org/10.1097/00005373-199705000-00016