혈역학적으로 불안정한 골반골 골절에서의 동맥 색전술의 유용성
Effectiveness of Arterial Embolization in HemodynamicallyUnstable Pelvic Fracture
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목적: 혈관 손상에 의해 혈역학적으로 불안정한 골반골 골절에서 혈관 조영술 및 동맥 색전술의 유용성 및 적절한 시술 시기에 대하여 알아보고자 하였다. 대상 및 방법: 2002년 5월부터 2007년 2월까지 골반골 골절로 입원했던 환자 중 혈관 조영술 및 동맥 색전술을 시행하였던 환 자 19례를 대상으로 혈압, 맥박, 혈색소 수치, 프로트롬빈 시간, 부분 트롬보플라스틴 시간, 혈소판 수치에 대하여 응급실 내원 당시, 혈관 조영술 및 동맥 색전술을 시행 하기 직전, 시행 후의 세 시기로 나누어 후향적으로 비교 연구 하였고 이에 따른 통계 적 분석은 repeated measures analysis of variance을 사용하였다. 결과: 혈압은 동맥 색전술을 시행한 후의 결과가 시행전과 비교하였을 때 유의하게 회복되는 것을 보였고, 혈색소 수치와 프로 트롬빈 시간은 응급실 도착시와 동맥색전술 시행전에는 통계학적으로 유의하게 결과가 악화되다가 , 동맥색전술 시행전과 시행 후, 통계학적으로 유의하게 회복되는 것을 보였다. 부분 트롬보플라스틴 시간, 혈소판 수치는 응급실 도착 시와 동맥 색전술을 시행하기 전까지 유의하게 악화되는 소견을 보였다. 결론: 혈압, 혈색소 수치, 프로트롬빈 시간, 부분 트롬보플라스틴 시간, 혈소판 수치의 변화가 빠르나 수액 및 수혈 요법에 반응 하지 않는 혈역학적으로 불안정성 골반골 골절은 혈관 조영 및 동맥 색전술을 진단 및 치료 방법으로 고려해 볼 수 있다.
Abstract
Purpose: To assess the effectiveness and appropriate time for arterial embolization with angiography in patients who sustained a hemodynamically unstable pelvic bone fracture Materials and methods: Nineteen cases with hemodynamically unstable pelvic bone fractures that were managed with arterial embolization out of 287 pelvic bone fractures between May, 2002 and February, 2007 were reviewed retrospectively. The blood pressure, pulse rate, hemoglobin, prothrombin time, partial prothrombin time and platelet checked were evaluated immediately after arrival at the emergency room, before and after embolization. Repeated measures analysis of variance was used for the statistical evaluation. Results: The blood pressure showed a statistically significant increase from before and after embolization. The hemoglobin and prothrombin time checked upon arrival were significantly lower than those checked before embolization. In addition, the hemoglobin and prothrombin time was significantly higher before embolization than after embolization. The partial thromboplastin time and platelet checked immediately upon arrival were significantly lower than those checked before embolization. Conclusion: Interventional angiography and embolization can be an effective treatment modality in patients with hemodynamically unstable pelvic bone fractures showing rapid changes in the hemoglobin level, prothrombin time, partial thromboplastin time and platelet count but little response to fluid and transfusion resuscitation,.
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