创伤大输血患者死亡危险因素分析  

Mortality risk factors analysis of trauma patients with massive transfusion

作　　者：刘月高[1] 钱永兵 田锐[1] 金卫[1] 葛芳侠 吕慧 陆健[1] 

机构地区：[1]上海交通大学附属第一人民医院危重病科,上海201620 [2]上海交通大学附属仁济医院,上海200001

出　　处：《中国急救医学》2018年第1期57-62,共6页Chinese Journal of Critical Care Medicine

基　　金：上海卫生计生系统重要薄弱学科建设计划（2016ZB0205）

摘　　要：目的探讨创伤大输血患者院内死亡的独立危险因素。方法回顾性队列研究分析2006-11-2015-06上海交通大学附属第一人民医院危重病科接受过大输血方案治疗的所有创伤大出血患者。通过单因素和多因素Logistic回归分析法对23个潜在影响创伤大输血患者死亡相关危险因素进行研究。结果133例患者符合纳入研究。多因素Logistic回归分析筛选出与创伤大输血患者住院24h死亡相关独立危险因素有初始血红蛋白（Hb，OR6．664，P=0．021，95％CI1．332～33．326）、新鲜冰冻血浆：浓缩红细胞比例[（FFP：PRBC），OR1．934，P=0．007，95％CI1．195-3．131）]；住院30d死亡相关的独立危险因素有序贯器官衰竭估计评分（SOFA评分，OR7．278，P=0．004，95％CI1．908～27．757）、骨盆骨折（OR3．080，P=0．039，95％CI1．060～8．951）。结论初始Hb、FFP：PRBC可能是创伤大输血患者院内24h死亡相关的独立危险因素；SOFA评分、骨盆骨折可能是创伤大输血患者院内30d死亡相关的独立危险因素。Objective To explore the independent risk factors related to the mortality of massive transfusion trauma patients during the 30 - day hospitalization. Methods Retrospective cohort study （analysis） was performed for the trauma patients who received massive transfusion in Shanghai General Hospital from November 2006 to June 2015, potential risk factors resulted in the death of these trauma patients were analyzed via single and multiple factors logistic regression analysis. Results Totally, 133 patients were included in the current study according to the inclusion criteria. Muhivariable Logistic regression analysis screened the following independent risk factors that related to the mortality of massive transfusion patients during the 24 h hospitalization： hemoglobin （ Hb, OR 6. 664, P = O. 021, 95% CI 1. 332 -33. 326）, fresh frozen plasma： concentration of red blood cells （FFP ： PRBC, OR 1. 934, P =0.007, 95% CI 1. 195 ~ 3. 131 ） ; the independent risk factors that related to the mortality of massive transfusion patients during the 30 - day hospitalization were as follow ： sequential organ failure assessment （ SOFA, OR 7. 278, P = O. 004, 95% CI 1. 908 - 27. 757 ）, pelvic fractures （ OR 3. 080, P = 0. 039, 95% CI 1. 060 - 8. 951 ）. Conclusion Hb, FFP ： PRBC may be served as the independent risk factors that related to the mortality of massive transfusion patients during the 24 h hospitalization. SOFA, pelvic fractures may be served as the independent risk factors that related to the mortality of massive transfusion patients during the 30 d hospitalization.

关 键 词：创伤 大输血 病死率 危险因素 

分 类 号：R563.1[医药卫生—呼吸系统]