严重胸部创伤病死率的相关因素分析

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.%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. Re-sults Seven factors were found to be correlated with the mortality of SCT: age, hemorrhagie 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: hemorrhagie shock (fi = 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, Off = 1.210, P=0.005), and thorax AIS score 3≥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 (hemorrhagie 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.