摘要
目的探索重症创伤患者1周内发生死亡的相关危险因素,为临床医师早期识别危重患者提供理论依据。方法回顾性分析2016年1月—2019年12月武汉市第三医院重症医学科(ICU)收治的重症创伤患者244例,分析患者伤后1周内发生死亡的相关危险因素。将患者分为存活组(188例)和死亡组(56例),比较两组患者基线资料、伤后至入ICU时间,入院24h内实验室指标、损伤严重度评分(ISS)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、ICU住院时间。利用受试者工作特征(ROC)曲线评估相关指标预测重症创伤患者早期发生死亡的能力。结果56例死亡,全因病死率22.95%。两组患者性别、年龄、致伤原因、致伤部位、创伤后休克发生率比较均无统计学差异,P>0.05。与存活组比较,死亡组更早入ICU[(1.71±1.15)h vs.(2.78±2.41)h],ISS、APACHEⅡ评分更高[(23.35±3.41)分vs.(17.71±4.07)分、(32.18±7.50)分vs.(17.86±12.61)分],ICU住院时间更短[(3.79±4.60)d vs.(6.78±5.65)d,P<0.05]。与存活组比较,死亡组入院24h内血乳酸(Lac)水平更高[(9.63±5.81)mmol/L vs.(3.95±2.89)mmol/L]。凝血酶原时间(PT)、部分活化凝血酶时间(APTT)水平更高,分别为[(28.65±32.28)s vs.(13.57±11.55)s]、[(72.99±62.44)s vs.(27.47±17.36)s],D-二聚体(D-D)水平更高[88.23(66.75,107.12)mg/L vs.21.63(16.89,31.67)mg/L],纤维蛋白原(Fib)水平更低[(1.69±0.70)g/L vs.(2.42±0.89)g/L]。重症创伤患者中创伤性凝血病(TIC)发生率18.03%,死亡组发生TIC显著高于存活组[(64.29%vs.4.26%),P<0.05],ROC曲线分析显示Lac水平及APACHEⅡ评分对重症创伤患者发生死亡有预测价值(P<0.05),曲线下面积(AUC)分别为0.810、0.925,95%CI分别为(0.806、0.914)、(0.857、0.993),Lac最佳临界为3.7mmol/L,APACH EⅡ评分最佳临界值为25分。结论对于重症创伤患者,Lac水平≥3.7mmol/L及APACHEⅡ评分≥25分对1周内发生死亡有预测价值。
Objective To explore the risk factors related to death in severe trauma patients within 1 week,and provide a theoretical basis for clinicians to identify critically ill patients early.Methods A retrospective analysis was conducted in severe trauma patients admitted to the ICU of Wuhan Third Hospital from Jan.2016 to Dec.2019.The risk factors related to death of patients within 1 week after injury were analyzed,and patients were divided into survival group(n=188)and death group(n=56).Patients'baseline data,time from injury to ICU admission,laboratory indicators within 24 hours of admission,injury severity scale(ISS),acute physiology and chronic health score Ⅱ(APACHE Ⅱ),and ICU hospital stay were compared.The receiver operating characteristic(ROC)curve was used to evaluate the ability of relevant indicators to predict the early death of severe trauma patients.Results A total of 244 patients with severe trauma were included,of whom 56 died,and the all-cause mortality rate was 22.95%.There was no statistical difference between the two groups in gender,age,trauma reason,trauma site,or incidence of post-traumatic shock(P>0.05).Compared with the survival group,the death group entered the ICU earlier[(1.71±1.15)hours vs.(2.78±2.41)hours],the scores of ISS and APACHEⅡ were higher[(23.35±3.41)points vs.(17.71±4.07)points,(32.18±7.50)points vs.(17.86±12.61)points],and the ICU hospitalization time was shorter[(3.79±4.60)days vs.(6.78±5.65)days,P<0.05].Compared with the survival group,the blood lactate level in the death group was higher within 24 hours after admission[(9.63±5.81)mmol/L vs.(3.95±2.89)mmol/L].The levels of PT and APTT were higher[(28.65±32.28)s vs.(13.57±11.55)s],[(72.99±62.44)s vs.(27.47±17.36)s],the D-dimer level was higher[88.23(66.75,107.12)mg/L vs.21.63(16.89,31.67)mg/L],and the level of fibrinogen was lower[(1.69±0.70)g/L vs.(2.42±0.89)g/L].In severe trauma patients,the incidence of traumatic coagulopathy(TIC)was 18.03%,and the incidence of TIC in the death group was significantly higher than that in the survival group(64.29%vs.4.26%,P<0.05).ROC curve analysis showed that blood lactic acid level and APACHEⅡ score had predictive value for the death of severe trauma patients(P<0.05),the area under the curve(AUC)were 0.810 and 0.925,respectively,and the 95%CI were(0.806,0.914),(0.857,0.993),respectively.The best cut-off value of blood lactic acid was 3.7mmol/L,and the best cut-off value of APACHEⅡ score was 25 points.Conclusion For patients with severe trauma,lactic acid level≥3.7mmol/L and APACHEⅡ score≥25 have predictive value for death within one week.
作者
邓淑萍
邱红
王斌
董芳
Deng Shuping;Qiu Hong;Wang Bin;Dong Fang(Department of Critical Care Medicine,Wuhan Third Hospital,Wuhan 430060,China)
出处
《创伤外科杂志》
2021年第10期771-774,780,共5页
Journal of Traumatic Surgery
