急诊科成人创伤患者院内死亡危险因素分析  

Analysis of the Risk Factors of In-hospital Death in Adult Trauma Patients at the Emergency Department

作　　者：李蕙伊 刘畅[1] 赵洋子 曾仁庆 甘淼 王涛[2] 于诗源 崇巍[1] 

机构地区：[1]中国医科大学附属第一医院急诊科,沈阳110001 [2]中国医科大学附属盛京医院急诊科,沈阳110004 [3]中山大学医学院附属肿瘤医院神经外科,广州510080

出　　处：《中国医科大学学报》2018年第2期128-131,共4页Journal of China Medical University

基　　金：辽宁省自然科学基金(201602815)

摘　　要：目的探讨急诊科成人创伤患者的院内死亡危险因素。方法分析2016年8月至2017年2月中国医科大学附属第一医院急诊科86例成人创伤患者的临床资料,根据在院期间是否死亡,分为存活组和死亡组。记录2组患者性别、年龄、就诊时心率(HR)、血氧饱和度(SpO_2)、平均动脉压(MAP);首次外周血白细胞计数(WBC)、血清肌酐(Cr)、血清尿素氮(BUN)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血红蛋白(Hb)、外周血血小板计数(PLT)、血清白蛋白(ALB)、纤维蛋白原水平(Fg)、谷丙转氨酶(ALT)和总胆红素(TBil);计算格拉斯哥昏迷评分(GCS)、序贯器官衰竭(SOFA评分)、损伤严重程度评分(ISS)。采用SPSS 22.0软件进行统计学分析,按P<0.1筛选出2组差异显著的指标,将其纳入logistic回归,得出院内死亡的独立危险因素,绘制这些因素与院内死亡关系的受试者工作特征(ROC)曲线,计算ROC曲线下面积,评估其对院内死亡的预测效能。结果 logistic回归得出GCS(β=-0.957,OR=0.384,P=0.012)、SOFA评分(β=0.966,OR=2.627,P<0.001)为患者院内死亡的独立危险因素。GCS和SOFA评分的ROC曲线下面积分别为0.989和0.982。结论 SOFA评分和GCS均为急诊创伤患者院内死亡的独立危险因素,提示创伤患者来诊时的脏器功能状态(尤其是脑功能状态)与预后关系密切。Objective To accurately assess the condition of trauma patients at the emergency department （ED） ,the risk factors of in-hospital death were explored. Methods A total of 86 emergency trauma patients were retrospectively investigated. They were divided into survival and non-survival groups, in the First Hospital of China Medical University, from August 2016 to February 2017. Clinical pa- rameters, such as sex, age, heart rate, oxygen saturation, mean arterial pressure, white blood cell count, serum creatinine, urea nitrogen, prothrombin time, activated partial thromboplastin time, hemoglobin, platelet count, serum albumin, fibrinogen, glutamic-pyruvic, total bilirubin, Glasgow coma scale （GCS） , sequential organ failure assessment （SOFA） score, and injury severity score were evaluated and recorded. The parameters which were significantly different （P 〈 0.1） between the two groups were analyzed using the logistic regression analysis to determine the independent risk factors of death at the ED. Receiver-operating characteristic curves were drawn to evaluate lheir prognostic abilities. Results GCS and SOFA score were the independent risk factors of in-hospital death in trauma patients （P 〈 0.05）. Conclusion Organ function, especially that of the brain, is closely related to the prognosis of adult trauma patients.

关 键 词：急诊科 创伤 预后 格拉斯哥昏迷评分 序贯器官衰竭评分 

分 类 号：R641[医药卫生—外科学]