浙江省8家医院创伤患者死亡危险因素分析  

An analysis of the risk factors in the mortality of casualties： data from eight hospitals in Zhejiangprovince

作　　者：陈卫强[1] 李辉[2] 马岳峰[2] 沈伟锋[2] 何小军[3] 伍峻松[2] 易建华[2] 

机构地区：[1]杭州市卫生局,杭州310009 [2]浙江大学医学院附属第二医院急诊中心 [3]中华急诊医学杂志编辑部

出　　处：《中华急诊医学杂志》2011年第3期297-301,共5页Chinese Journal of Emergency Medicine

基　　金：卫生部科学研究基金（WKJ2007-2-013）

摘　　要：目的探讨导致创伤患者死亡的危险因素以及改进创伤急救的措施。方法整理2009年全年浙江省8所医院急诊室首诊的创伤患者的病例资料，结合创伤急救的各个环节，挑选可能导致患者死亡的相关因素，通过单因素和多因素Logistic回归分析方法，得到导致创伤患者死亡的独立危险因素。结果2009年浙江省8所医院共有3659名患者纳入了本次研究，其中死亡226人，病死率为6．18％。单因素分析结果提示，年龄、创伤机制、ISS评分、GCS评分、专业现场急救、转送途中气管插管、转送途中清创止血、人院时低血压、昏迷、急诊室胸腔闭式引流、急诊手术、ICU内中心静脉压监测和ICU内机械通气的患者死亡相关。多因素Logistic回归分析提示，GCS评分、ISS评分、机械通气、人院时低血压、年龄是患者死亡的独立危险因素，有效的专业现场急救是保护因素。结论患者的伤情严重程度和年龄是影响患者结局的重要因素。加强院前急救，早期稳定患者伤情以及合理使用ICU内监护设施有助于进一步降低创伤救治的病死率。Objective To explore risk factors in the mortality of casualties and to find a way to improve trauma emergency service. Method The possible factors likely related to the mortality of casualties were taken into account based on each stage of trauma emergency so as to find the independent risk factors by using univariate and multivariate analyses. Results A total of 3 659 casualties were enrolled in this study. Of them, 226 casuahies died and the mortality rate was 6.18%. Following factors were related to mortality after univariate analysis： age, cause of trauma, injury severity score, Glasgow come scale come on the scene, professional emergency treatment on the scene, intubation in the ambulance, debridement and hemostasis in the ambulance, low blood pressure at admission, closed drainage of pleural cavity, emergency operation, CVP monitoring in ICU and mechanical ventilation in ICU. After muhivariate analysis, six factors were independently related to the mortality of casualties as follows： Glasgow coma scale, injury severity score, mechanical ventilation, blood pressure at admission, age and professional emergency treatment on the scene. Conclusions It has a great significance to investigate the risk factors of mortality for casualties. Severity of trauma and age were independently associated with the outcomes of trauma. Besides, improving prehospital care and stabilizing the trauma patients in early phase can further decrease the mortality.

关 键 词：创伤 死亡 危险因素 院前急救 休克 

分 类 号：R641[医药卫生—外科学]