中国医学科学院学报

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中国医学科学院学报

中国医学科学院学报 ›› 2013, Vol. 35 ›› Issue (1): 74-79.doi: 10.3881/j.issn.1000-503X.2013.01.014

• 论著 • 上一篇    下一篇

严重胸部创伤病死率的相关因素分析

刘云1,都定元2,胡旭1,夏道奎1,向小勇3,周继红4,刘朝兵1   

  1. 1三峡大学第一临床医学院胸心外科,湖北宜昌 4430032重庆市急救医疗中心,重庆 4000143重庆医科大学附属第一医院胸心外科,重庆 4000164第三军医大学附属大坪医院野战外科研究所创伤、烧伤、复合伤国家重点实验室,重庆 400042
  • 收稿日期:2011-11-21 出版日期:2013-03-07 发布日期:2013-03-07
  • 通讯作者: 夏道奎 电话:0717-6486527,电子邮件:ly.1982_818@163.com E-mail:ly.1982_818@163.com
  • 基金资助:
    重庆市科委重大科技专项基金(2008AA0011)、重庆市科委应用基础研究基金(97-4714)和重庆市卫生局医学科学技术研究重点项目(2010-1-52)

Risk Factors of Mortality in Severe Chest Trauma Patients

LIU Yun1, DU Ding-yuan2, HU Xu1, XIA Dao-kui1, XIANG Xiao-yong3, ZHOU Ji-hong4, LIU Chao-bing1   

  1. 1Department of Cardiothoracic Surgery, the First College of Clinical Medical Science, China Three Gorges University, Yichang, Hubei 443003, China2Department of Cardiothoracic Surgery, Chongqing Emergency Medical Center, Chongqing 400014, China3Department of Cardiothoracic Surgery, the First Affiliated Hospital, Chongqing Medicine University, Chongqing 400016, China4State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China
  • Received:2011-11-21 Online:2013-03-07 Published:2013-03-07
  • Supported by:
    Supported by the Chongqing Municipal Science and Technology Commission of Major Scientific and Technological Special Fund (2008AA0011), Chongqing Municipal Science and Technology Commission Applied Basic Research Funds (97-4714),and Chongqing Municipal Health Bureau Medical Science and Technology Research Project (2010-1-52)

摘要: 目的 分析严重胸部创伤病死率的相关因素。方法 回顾性分析2006年1月至2009年4月重庆市急救医疗中心收治的777例严重胸部创伤患者资料,对影响其病死率的15项相关因素进行多因素逐步Logistic回归分析。结果 对严重胸部创伤病死率有价值的相关因素分别是年龄、失血性休克、多器官功能障碍综合征(MODS)、肺部感染、腹腔脏器损伤、格拉斯哥昏迷评分(GCS)、胸简明损伤定级标准(AIS),其中影响严重胸部创伤病死率的最终独立危险因素有5个,分别为失血性休克 (B=1.710,OR=1.291,P=0.001)、MODS (B=3.453,OR=1.028,P<0.001)、肺部感染 (B=2.396,OR=10.941,P<0.001)、腹腔脏器损伤 (B=1.542,OR=1.210,P=0.005)、胸AIS值≥4 (B=0.487,OR=1.622,P<0.001);影响严重胸部创伤病死率的保护因素有2个,分别为年龄≤60岁 (B=-0.035,OR=0.962,P=0.01)、GCS值≥12 (B=-0.635,OR=0.320,P<0.001)。结论 年龄、严重并发症、伤情准确诊断与评估是预测创伤后救治结局的相关因素,针对这些因素制定有效的治疗方案是提高严重胸部创伤患者生存率的关键。   

关键词: 胸部创伤, 病死率, 危险因素

Abstract: Objective To investigate the risk factors of mortality in patients with severe chest trauma(SCT). Methods The clinical data of 777 SCT [abbreviated injury scale (AIS) ≥3] patients who were treated in the Chongqing Emergency Medical Center from January 2006 to April 2009 were retrospectively reviewed. Stepwise logistic regression analysis was used to explore 15 possible mortality-related risk factors. Results Seven factors were found to be correlated with the mortality of SCT: age, hemorrhagic shock, multiple organ dysfunction syndrome (MODS), pulmonary infection, abdominal organ injury, Glasgow coma scale (GCS) score, and thorax AIS score. Among them five factors were the independent factors that might increase the mortality of SCT: hemorrhagic shock (B=1.710, OR=1.291, P=0.001), MODS (B=3.453, OR=1.028, P<0.001), pulmonary infection (B=2.396, OR=10.941, P<0.001), abdominal organ injury (B=1.542, OR=1.210, P=0.005), and thorax AIS score ≥4 (B=0.487, OR=1.622, P<0.001). Two factors showed protective effects: age ≤60 years (B=-0.035, OR=0.962, P=0.01) and GCS score ≥12 (B=-0.635, OR=0.320, P<0.001). Conclusions Age, disease severity, and complications (hemorrhagic shock, MODS, and pulmonary infection) are independent risk factors of the mortality of SCT. Effective treatment programs targeting these risk factors may improve the outcomes of SCT patients.

Key words: chest trauma, mortality, risk factors

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