多发伤患者应激并发症危险因素的logistic回归分析  

Logistic regression analysis of risk factors of stress complications in patients with multiple trauma

作　　者：徐文鹏[1] 应佑国[2] 方玉明[1] 秦宗和[2] 

机构地区：[1]上海交通大学医学院附属第三人民医院急诊科,上海201900 [2]上海交通大学医学院附属第三人民医院重症医学科,上海201900

出　　处：《蚌埠医学院学报》2014年第11期1473-1476,共4页Journal of Bengbu Medical College

基　　金：上海交通大学医学院附属第三人民医院自然科学研究资助项目(syz2001-09)

摘　　要：目的：探讨导致多发伤患者应激并发症相关的危险因素。方法：对64例多发伤患者应激并发症危险因素的相关指标进行单因素及多因素logistic回归分析,收集血常规、C反应蛋白、血糖、血电解质、血气分析、肝肾功能等指标以及测定血清总三碘甲状腺原氨酸（TT3）、血清游离三碘甲状腺原氨酸（FT3）、血清总甲状腺素（TT4）、血清游离总甲状腺素、促甲状腺激素、促肾上腺皮质激素（ACTH）、血皮质醇（COR）、生长激素,细胞因子白介素（IL）-1、IL-6、IL-8、IL-10、肿瘤坏死因子（TNF-α）等。结果：64例出现应激性溃疡、急性呼吸窘迫综合征等应激并发症48例,出现应激并发症和无并发症患者,急性生理与慢性健康（APACH）Ⅱ评分、COR、ACTH、TT3、FT3、TT4、IL-6、IL-8、IL-10、TNF-α等差异均有统计学意义（P〈0.05-P〈0.01）;多因素logistic分析表明,APACHⅡ评分、TT4、COR、IL-6和IL-10为早期应激并发症的独立危险因素（P〈0.05-P〈0.01）。结论：多发伤患者APACHⅡ评分以及创伤后TT4、COR、IL-6、IL-10等指标的变化与患者应激性消化道出血及呼吸窘迫综合征等应激并发症的出现密切相关。Objective： To investigate the risk factors of stress complications in patients with multiple trauma. Methods： The clinical data of stress complications in 64 patients with multiple trauma were analyzed by univariate and multivariate binary Logistic regression.The data of routine blood,c-reactive protein,blood sugar,blood electrolytes,blood gas analysis,indexes of liver and kidney function,serum total iodine thyroid glycine（ TT3）,serum free thyroid original three iodine glycine（ FT3）,total serum thyroxine（ TT4）,serum free thyroid hormone,thyroid stimulating hormone,adrenocorticotropic hormone（ ACTH）,blood cortisol（ COR）,growth hormone,cytokine interleukin（ IL）-1,IL-6,IL 8,IL-10 and tumor necrosis factor（ TNF-α） in all cases were investigated. Results： The stress ulcer and acute respire distress syndrome of stress complications were found in 48 cases. The differences of the grade Ⅱ scores of acute phsiology and chronic health（ APACHⅡ）,COR,ACTH,TT3,FT3,TT4,IL-6,IL-8,IL-10 and TNF-α between patients with stress complications and patients without stress complications were statistically significant（ P〈0. 05 to P〈0. 01）. The multivariate analysis showed that APACHⅡ grade,cortisol,TT4,IL-6 and IL-10 were the independent risk factor of early stress complication（ P〈0. 05 to P〈0. 01）.Conclusions： The levels of APACH grade Ⅱ,Cortisol,TT4,IL-6 and IL-10 are obviously correlated with the stress gastrointestinal bleeding and respiratory distress syndrome in patients with multiple trauma.

关 键 词：多处创伤 应激 并发症 危险因素 

分 类 号：R641[医药卫生—外科学]