探讨多发伤合并不稳定型骨盆骨折的死亡因素及早期救治策略

摘要

Objective To investigate the death influence factors and early treatment strategies of unstable pelvic fractures with polytrauma. Methods The clinical data of 79 patients with unstable pelvic fractures and polytrauma admitted into the Department of Emergency Surgery of the Second Affiliated Hospital of Anhui Medical University from Jan.2010 to Dec.2014 were analyzed retrospectively.There were 53 males and 26 females.The average age was (37.6 ±9.8) years.Forty-one patients were injured by road traffic,26 patients were injured by falling from high places,7 patients were injured by heavy hit,and 5 patients were injured by others.Forty-three pa-tients received nonoperative treatment;16 patients received interventive treatment and 24 patients received operative treatment.The patients were divided into two groups according to whether the patients died or not: the survivor group(n=68)and the death group(n=11).The clinical data was compared between the two groups to analyze the death factors.The early treatment strategy was also explored through investigating treatment methods.Results E-leven patients died in this study.Univariate analysis revealed that in the two groups,age (t=0.926,P=0.357) and time of admission after injury (t=0.009,P=0.993) had no significant difference.But shock(χ2 =9.050,P=0.003),ISS(t=5.525,P=0.000),the volume of blood transfusion(t=3.820,P=0.000 ) and the number of the injured sites(t=2.976,P=0.008) were factors of death in patients.Further multivariate analysis showed that ISS (OR=1.179,95%CI:1.027-1.353,P<0.05)and the volume of blood transfusion(OR=0.730,95%CI:0.596-0.894,P<0.05) were independent risk factors of death.Conclusion Shock,ISS,volume of blood transfusion and the number of the injured sites are factors of death in patients with unstable pelvic fractures and polytrauma.Bleed-ing control in the early stage is the key for treatment.%目的 探讨多发伤合并不稳定型骨盆骨折的死亡影响因素及早期救治策略.方法 回顾性分析安徽医科大学第二附属医院急诊外科2010年1月~2014年12月收治的79例多发伤合并不稳定型骨盆骨折患者的临床资料,其中男性53例,女性26例;平均年龄(37.6±9.8)岁.致伤原因:道路交通伤41例,高处坠落伤26例,重物砸伤7例,其他5例.非手术治疗43例,介入治疗16例,手术治疗24例.根据患者是否死亡,分为存活组(68例)和死亡组(11例).比较两组患者的临床参数,分析死亡影响因素;并根据患者治疗方案的选择探讨早期救治策略.结果 79例患者中死亡11例,单因素分析发现患者的死亡原因、年龄(t=0.926,P=0.357)、伤后至入院时间(t=0.009,P=0.993),存活组与死亡组无明显差异,但是患者是否合并休克(χ2=9.050,P=0.003)、损伤严重度评分(ISS)(t=5.225,P=0.000)、输血量(t=3.820,P=0.000)及损伤部位数(t=2.976,P=0.008)是患者死亡的影响因素;进一步多因素分析显示,ISS(OR=1.179,95%CI:1.027~1.353,P<0.05)和输血量(OR=0.730,95%CI:0.596~0.894,P<0.05)是患者死亡的独立危险因素.结论 休克、ISS、输血量及损伤部位数是影响多发伤合并不稳定型骨盆骨折患者死亡的因素;早期确定性止血是患者救治的关键.