肺挫伤所致急性呼吸窘迫综合征预后相关因素的Logistic分析

摘要

目的：探讨肺挫伤所致急性呼吸窘迫综合征患者病死率密切相关的影响因素。方法112例肺挫伤所致急性呼吸窘迫综合征患者的各项临床指标进行统计分析以明确影响病死率的独立相关因素，根据患者预后，分为生存组和死亡组。研究的因素包括性别、年龄、伤后时间、是否合并多发伤、是否发生低血容量性休克、血小板计数、手术与否、血糖值、有无合并基础疾病、ISS 评分及 TSS 评分。应用单因素、多因素 Lo-gistic 回归分析肺挫伤所导致的急性呼吸窘迫综合征。结果两组间性别、手术与否差异无统计学意义（P ＞0.05），而年龄、伤后时间、低血容量休克、血小板计数、血糖、存在基础疾病、ISS 评分及 TSS 评分差异有统计学意义（P ＜0.05）。多因素 Logistic 分析发现，影响此类患者预后的独立危险因素为年龄≥60岁、伤后时间、合并多发伤、低血容量休克、血小板计数≤80×109／L、有基础疾病、ISS≥30分和 TSS≥15分。结论肺挫伤所致急性呼吸窘迫综合征病死率高，以上独立危险因素可以为正确判断病情提供重要依据。%Objective To investigate the risk factors of mortality in patients with acute respiratory distress syndrome caused by pulmonary contusion.Methods 112 patients with acute respiratory distress syndrome caused by pulmonary contusion were enrolled in the study,and they were divided into the survival group and the death group ac-cording to their prognosis.The factors relevant to outcomes included age,gender,time after injury,multiple inju-ries,hemorrhagic shock,platelet count,operations,blood sugar,basis diseases,ISS and TSS.All these factors were measured and analyzed by univariate and multivariate logistic regression to form a regression model.Results Univa-riate logistical regression analysis showed that ages,time after injury,multiple injuries,hemorrhagic shock,platelet count,basis diseases,ISS scores and TSS scores were closely connected with the prognosis of acute respiratory dis-tress syndrome caused by pulmonary contusion between the two groups (P <0.05),while no statistical significance was noted in gender and operations (P >0.05).By multivariate logistical regression analysis,age≥60 years,time after injury,multiple injuries,hemorrhagic shock,platelet count≤80 ×109 /L,basis diseases,ISS≥30 and TSS≥15 were independent risk factors for the prognosis of ARDS caused by pulmonary contusion.Conclusion The pa-tients with acute respiratory distress syndrome caused by pulmonary contusion have a high morbidity and mortality. The above independent risk factors can provide an important basis to diagnose the condition correctly.