目的：腹部鈍傷常見於各年齡層，且是致死的主因之一。外傷嚴重度分數被廣泛地用來預測創傷患者的死亡率及傷勢嚴重情形。本研究主要針對因不同意外事件而導致嚴重腹部鈍傷合併臟器出血患者進行流行病學的分析。方法：這是一項回溯性的研究，樣本為因意外事件造成內器出血及外傷嚴重度分數超過9分，且在2005年1月至2006年12月到中部某醫學中心就診的腹部鈍傷患者，分析內容包含：年齡、性別、受傷原因、外傷嚴重度分數、急診處置及結果等。結果：有效樣本數為28人，平均年齡32.5±16.7歲，外傷嚴重度的平均分數為20.8±13.5分；出血部位以肝臟撕裂傷造成居多（16人，57.1%），脾臟次之（5人，17.9%），且有8人(28.6%)的出血處達二個以上；肝臟撕裂傷達Ⅲ-Ⅴ級且藉由經導管動脈栓塞(TAE)處置的患者有7人，全存活且無併發症；而另有Ⅴ級的撕裂傷患者二人，一人於急診搶救無效後死亡，另一人則於手術中不治；外傷嚴重度分數在死亡率方面具顯著差異(p<0.01)。結論：車禍意外事件是造成嚴重腹部鈍傷的常見因素，肝臟是最易出血的臟器，可藉由電腦斷層掃描來確認診斷；嚴重程度高的肝臟撕裂傷患者可考慮施行經導管動脈栓塞術(TAE)來加以緊急治療；外傷嚴重度分數可用來輔助預測死亡率。
Objective: Blunt abdominal trauma (BAT) is a major cause of morbidity and mortality among all age groups. The Injury Severity Score (ISS) for predicating the mortality rate and severity of trauma patient injuries has been used worldwide. This study was an analysis of the epidemiology of severe and complex BAT patients with solid organ hemorrhage due to various accidents. Methods: This was a retrospective study of trauma patients with solid organ hemorrhage and ISS ? 9 points who visited a medical center hospital in the central part of Taiwan between January 2005 and December 2006. Age, gender, injury mechanisms, ISS, emergency management and outcome of patients were recorded. Results: A total of 28 patients qualified for this study. The mean age was 32.5±16.7 years and the mean ISS was 20.8±13.5 points. Solid organ hemorrhage was mainly liver laceration (16 patients, 57.1%) followed by spleen laceration (5 patients, 17.9%). There were 8 patients (28.6%) who had two or more solid organ injuries. Seven of 14 high-grade (grade III-V) liver laceration patients who received transcatheter arterial embolization (TAE) survived without complication. Two patients with grade V injuries died. ISS has a significant relationship to mortality rate (p<0.01). Conclusion: Traffic accidents are the most common cause of severe blunt abdominal injury. The majority of solid organ hemorrhage occurs in the liver and it can be confirmed by abdominal CT. TAE is an alternative treatment for patients with high-grade liver lacerations and ISS is a reliable predictor of mortality in these patients.
