多发伤患者并发多器官功能障碍综合征的危险因素分析  

Risk factor analysis of polytrauma patients combined with multiple organ dysfunction syndrome

作　　者：苗振军[1] 刘志祯[1] 周峰[1] 魏法星[1] 蔡华忠[1] 吕汪洄 Miao Zhenjun;Liu Zhizhen;Zhou Feng;Wei Faxing;Cai Huazhong;Lyu Wanghui(Department of Emergency,Affiliated Hospital of Jiangsu University,Zhenjiang 212001,China)

机构地区：[1]江苏大学附属医院急诊中心,江苏省镇江市212001

出　　处：《中华创伤杂志》2018年第12期1114-1119,共6页Chinese Journal of Trauma

摘　　要：目的探讨影响多发伤患者并发多器官功能障碍综合征(MODS)的危险因素。方法采用回顾性病例对照研究分析2011年12月-2017年6月江苏大学附属医院收治的299例多发伤患者临床资料,包括性别、年龄、有无基础疾病、损伤部位数目、损伤严重度评分(ISS)、入院24h内血红蛋白水平、中性粒细胞计数、白细胞计数、血小板计数、活化部分凝血活酶时间(APTT)、D-二聚体水平、入院24h内是否合并休克、入院3d后是否合并感染、是否实施损害控制手术、住院时间及预后结局等。根据MODS发生情况将患者分为MODS组(94例)和非MODS组(205例)。通过单因素分析和多因素Logistic回归分析筛选影响多发伤患者并发MODS的危险因素。对筛选出来的危险因素进一步行受试者工作特征(ROC)曲线分析。结果在单因素分析中,损伤部位数目、ISS、入院24h内血红蛋白水平、血小板计数、APTT、D-二聚体水平、入院24h内是否合并休克、入院3d后是否合并感染、是否实施损害控制手术及预后结局等10个指标,两组差异有统计学意义(P<0.05)。而性别、年龄、有无基础疾病、入院24h内中性粒细胞计数、白细胞计数及住院时间等6个指标,两组差异无统计学意义(P>0.05)。多因素Logistic回归分析显示ISS、入院24h内D-二聚体水平、入院24h内是否合并休克及入院3d后是否合并感染等4个指标与多发伤患者并发MODS显著相关(P<0.05)(OR分别为1.048,3.913,27.715和1.015)。ISS预测多发伤并发MODS的ROC曲线下面积Az=0.726(95%C10.667-0.784);D-二聚体ROC曲线下面积Az=0.638(95%CI0.571~0.706)。结论影响多发伤患者并发MODS的独立危险因素为ISS、入院24h内D-二聚体水平、入院24h内是否合并休克及入院3d后是否合并感染。在多发伤的救治过程中,应该重视患者损伤严重程度和凝血功能的评估,积极复苏纠正休克、预防和控制感染,可以减少和预防多发伤患者Objective To investigate the risk factors of polytrauma combined with multiple organ dysfunction syndrome (MODS).Methods A retrospective case control study was performed on the clinical data of 299 polytrauma patients admitted to the Affiliated Hospital of Jiangsu University from December 2011to June 2017.The collected information included gender,age,length of hospital stay, number of injured parts,injury severity scores (ISS),neutrophil count,leukocyte level,hemoglobin level,platelet count,activated partial thromboplastin time (APTT),and D-dimer level within 24 hours since admission.In addition,shock within 24hours since admission,infection after 3 days since admission, damage control surgery,underlying diseases and prognostic outcomes were also recorded.All the patients were divided into MODS group (94 patients)and non-MODS group (205 patients).Univariate and multivariate logistic regression analyses were used to determine the risk factors of polytrauma combined with MODS.Receiver operating characteristic (ROC)curve was applied to further analyze those risk factors identified by the former analyses.Results In the univariate analysis,there were statistically significant differences between the two groups in the number of injured parts,ISS,hemoglobin level, platelet count,APTT,D-dimer level within 24 hours since admission,shock within 24 hours since admission,infection after 3days since admission,damage control surgery and prognostic outcomes (P<0.05).No significant differences were found in gender,age,underlying disease,length of hospital stay, neutrophil level,the leukocyte level within 24hours since admission between the two groups (P>0.05). The multivariate logistic regression analysis showed that ISS (OR =1.048),shock within 24hours since admission (OR=3.913),infection after 3days since admission (OR =27.715),and D-dimer level within 24hours since admission (OR=1.015)were significantly associated with polytranma combined with MODS (P<0.05).In addition,the area under ROC curve of ISS was 0.726(95%CI 0.667-0.7

关 键 词：多处创伤 多器官功能衰竭 危险因素 D-二聚体 

分 类 号：R59[医药卫生—内科学]