目的：探讨导致多发伤患者应激并发症相关的危险因素。方法：对64例多发伤患者应激并发症危险因素的相关指标进行单因素及多因素logistic 回归分析,收集血常规、C反应蛋白、血糖、血电解质、血气分析、肝肾功能等指标以及测定血清总三碘甲状腺原氨酸(TT3)、血清游离三碘甲状腺原氨酸(FT3)、血清总甲状腺素(TT4)、血清游离总甲状腺素、促甲状腺激素、促肾上腺皮质激素( ACTH)、血皮质醇( COR)、生长激素,细胞因子白介素( IL)-1、IL-6、IL-8、IL-10、肿瘤坏死因子( TNF-α)等。结果：64例出现应激性溃疡、急性呼吸窘迫综合征等应激并发症48例,出现应激并发症和无并发症患者,急性生理与慢性健康(APACH)Ⅱ评分、COR、ACTH、TT3、FT3、TT4、IL-6、IL-8、IL-10、TNF-α等差异均有统计学意义(P<0.05~P<0.01)；多因素logistic分析表明,APACH Ⅱ评分、TT4、COR、IL-6和IL-10为早期应激并发症的独立危险因素(P<0.05~P<0.01)。结论：多发伤患者APACHⅡ评分以及创伤后TT4、COR、IL-6、IL-10等指标的变化与患者应激性消化道出血及呼吸窘迫综合征等应激并发症的出现密切相关。%Objective:To investigate the risk factors of stress complications in patients with multiple trauma. Methods:The clinical data of stress complications in 64 patients with multiple trauma were analyzed by univariate and multivariate binary Logistic regression. The data of routine blood,c-reactive protein,blood sugar,blood electrolytes,blood gas analysis,indexes of liver and kidney function, serum total iodine thyroid glycine(TT3),serum free thyroid original three iodine glycine(FT3),total serum thyroxine(TT4),serum free thyroid hormone,thyroid stimulating hormone,adrenocorticotropic hormone(ACTH),blood cortisol(COR),growth hormone,cytokine interleukin(IL)-1,IL-6,IL 8,IL-10 and tumor necrosis factor(TNF-α) in all cases were investigated. Results:The stress ulcer and acute respire distress syndrome of stress complications were found in 48 cases. The differences of the gradeIIscores of acute phsiology and chronic health(APACHII),COR,ACTH,TT3,FT3,TT4,IL-6,IL-8,IL-10 and TNF-α between patients with stress complications and patients without stress complications were statistically significant(P<0. 05 to P<0. 01). The multivariate analysis showed that APACHII grade,cortisol,TT4,IL-6 and IL-10 were the independent risk factor of early stress complication(P<0. 05 to P<0. 01). Conclusions:The levels of APACH gradeII, Cortisol, TT4, IL-6 and IL-10 are obviously correlated with the stress gastrointestinal bleeding and respiratory distress syndrome in patients with multiple trauma.
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