关键词: 肝损伤, 手术治疗, 危险因素

Abstract:

Risk factors for operative management with blunt liver injury: A report of 102 cases        HUANG Chao，ZHANG Kun，JIANG Yi. Department of Hepatobiliary Surgery，Fuzong Medical College of Fujian Medical University，Fuzhou General Hospital of Nanjing Military Command, Fuzhou 350025, China
Corresponding author：ZHANG Kun，E-mail：zhangkun73@aliyun.com
Abstract    Objective    To investigate the risk factors for operative management with blunt liver injury. Methods    One hundred and two cases of blunt liver injury admitted in the Fuzhou General Hospital of Nanjing Military Command between October 1，2003 and May 1，2016 were reviewed retrospectively. The grading of the liver injury was verified by using surgical operation or CT scans. According to whether were operative management，and depending on the American Association for the Surgery of Trauma-organ injury scale (AAST-OIS) and imaging Becker rating，all the cases were divided into operative management group and non-operative management group，including 23 cases of grade Ⅰ，33 cases of grade Ⅱ，24 cases of grade Ⅲ，18 cases of grade Ⅳ，and 4 cases of grade Ⅴ. Univariate and multivariate Logistic analysis were performed to investigate correlative factors of operative management with blunt liver injury to identify independent risk factors of operative management with blunt liver injury. Using receiver operating characteristic curse，it determined the threshold of independent risk factors of operative management with blunt liver injury. Results Univariate analysis showed that correlative factors of operative management with blunt liver injury include alanine aminotransferase，aspartate aminotransferase，hemoglobin，hematocrit，serum potassium，heart rate，systolic blood pressure，the American Society for Surgery of Trauma-organ injury scale，peritoneal irritation，merger intraperitoneal other organ damage. Pearson product-moment correlation coefficient analysis showed that levels of serum potassium and sodium were correlated negatively，levels of blood pressure and heart rate were correlated negatively，levels of alanine aminotransferase and aspartate aminotransferase were correlated positively，and the liver grading and peritoneal irritation were correlated positively in both groups. Alanine aminotransferase，serum potassium and systolic blood pressure of the best threshold of operative management with blunt liver injury were 171.5 U/L，3.625 mmol/L，96.5 mmHg （1 mmHg=0.133 kPa）respectively by the ROC curve. Logistic multivariate regression analysis showed that blood pressure <96.5mmHg，serum potassium <3.625 mmol / L，merger intraperitoneal other organ damage and peritoneal irritation were independent risk factors for operative management with blunt liver injury. Conclusion    Blood pressure <96.5 mmHg，serum potassium <3.625 mmol/ L，merger intraperitoneal other organ damage and peritoneal irritation were the high risk factors of operative management with blunt liver injury.

Key words: hepatic injury, operative management, risk factor