摘要
目的对重症监护室（intensive care unit，ICU）严重创伤预后影响因素进行评价，为当地严重创伤诊治提供临床依据。方法回顾性分析2011—2015年收治人上海长征医院ICU且损伤严重程度评分（injury severity score，ISS）≥25分的408例严重创伤患者，总结其流行病学特征，并对好转组、死亡及恶化组的性别、年龄、损伤部位、致伤原因、病程、并发症情况、治疗情况、ISS评分、急性生理与慢性健康Ⅱ评分（ acute physiology and chronic health evaluation, APACHE Ⅱ）评分等进行比较。结果好转332例、死亡及恶化76例，死亡及恶化组年龄较大，自行摔伤比例较高，内环境紊乱、休克、急性肾衰竭、急性呼吸窘迫综合征及多器官功能衰竭的比例及并发症数量均较高，机械通气、血液净化、心肺复苏的比例均较高，格拉斯哥昏迷评分（Glasgow coma scale，GCS）较低，APACHEⅡ评分较高。好转组损伤部位较多，且胸部、四肢及骨盆损伤的比例较高，手术治疗的比例较高且总住院天数较长。二元Logistic回归分析，筛选出年龄〉55岁、自行摔伤、多器官功能障碍综合征（multiple organ dysfunction syndrome，MODS）、APACHEⅡ评分〉20分及心肺复苏为ICU严重创伤死亡及恶化的危险因素。结论关注患者整体情况，积极防治并发症，保护脏器功能对于ICU严重创伤救治非常关键。
Objective To evaluate the prognosis-related factors of severe trauma in Intensive Care Unit, and to provide clinical reference for the diagnosis and treatment of severe trauma. Methods The clinical data of all 408 patients with severe trauma and ISS score ≥25 admitting to our ICU and from January 2011 to December 2015 were retrospectively analyzed. To summarize the epidemiological characteristics and compare gender, age, site of injury, cause of injury, duration, complications, treatment, ISS score and APACHE Ⅱ score between the improved group and the death or deterioration group. Results There were 332 people who were improved and 76 people who died or deteriorated. The patients of death and deterioration groups were older, has a higher proportion of self falls, environment disorder, shock, ARF, ARDS and MODS, more complications, and are more likely to accept mechanical ventilation, blood purification, CPR and lower GCS score and higher APACHE Ⅱ score. The improvement group has more sites of injury higher proportion of chest, limbs and pelvis injury, and is more likely to accept surgical operation and the longer hospital stay. Binary Logistic regression analysis shows that age 〉 55, self falls, MODS, APACHE Ⅱ〉 20 and CPR are risk factors of death and deterioration for the severe trauma in ICU. Conclusion It＇s essential to pay more attention to the overall situation of patients, preventing complications, and protecting the fimction of organs during the treatment of severe trauma in ICU.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2018年第2期194-199,共6页
Chinese Journal of Emergency Medicine
