多发肋骨骨折患者早期气管切开时机及预后的相关因素分析  

Analysis of timing and prognostic factors of early tracheotomy in patients with multiple rib fractures

作　　者：章兵 李功科 王玉荣 吴飞 时素琴 冯庆玲 杭欣 苗润丰 夏乐[1] 段成 冷俊岭[1] 李勇 Zhang Bing;Li Gongke;Wang Yurong;Wu Fei;Shi Suqin;Feng Qinling;Hang Xin;Miao Rurifeng;Xia Le;Duan Cheng;Leng Juling;Li Yong(Department of Emergency Intensive Care Unit,Affiliated Hospital of Yangzhou University,Yangzhou 225000,China)

机构地区：[1]扬州大学附属医院急诊重症医学科,225000

出　　处：《中华创伤杂志》2021年第7期646-652,共7页Chinese Journal of Trauma

摘　　要：目的探讨影响多发肋骨骨折患者早期气管切开时机及预后的相关因素。方法采用回顾性病例对照研究分析2013年2月至2019年10月扬州大学附属医院收治的222例多发肋骨骨折行气管切开患者临床资料,其中男160例,女66例;年龄18~85岁[(49.5 ± 16.3)岁]。根据气管切开时机实践管理指南和倾向得分匹配技术分组,匹配前有118例气管插管7 d内行气管切开(早期组)和104例气管插管7 d后气管切开(晚期组);匹配后早期组87例,晚期组87例。比较匹配前后早期组和晚期组性别、年龄、基础疾病、损伤严重度评分(ISS)、格拉斯哥昏迷评分(GCS)、骨折肋骨数、肋骨骨折总数(NTRF)、第1肋肋骨骨折、连枷胸、创伤性脑损伤、合并伤(脊椎、颌面部、胸骨)、急性呼吸窘迫综合征(ARDS)、肺挫伤容积分数(VPC)、血乳酸(入院24 h内)、血胸、气胸、机械通气时间、气管切开持续时间、气管插管至切开时间、住院时间、ICU住院时间、胸腔闭式引流术、纤维支气管镜检查次数、多重耐药菌感染、呼吸机相关性肺炎、抗生素使用时间、镇静镇痛药物使用时间及28 d病死率。采用多因素Logistic回归分析预测早期气管切开独立危险因素;采用皮尔逊法比较多因素之间的相互关系;采用受试者工作特征(ROC)曲线预测影响早期气管切开患者预后的指标,并计算最佳截断值;采用卡普兰 - 梅尔单因素和COX多因素生存分析影响患者28 d病死率的相关因素。结果 (1)早期组的NTRF、ARDS、VPC高于晚期组,而气管插管至切开时间及28 d病死率低于晚期组(P < 0.05);但性别、年龄、基础疾病及ISS等差异无统计学意义(P > 0.05)。(2)多因素Logistic回归分析显示NTRF(OR = 1.775,95%CI 1.439~2.188)、ARDS(OR = 3.740,95%CI 1.441~9.711)、VPC(OR = 1.087,95%CI 1.052~1.124)差异有统计学意义(P < 0.05);皮尔逊法分析显示NTRF与VPC之间有显著的相关性(r = 0.369,P < 0.05),ARDS与Objective To investigate the related factors that affect the timing and prognosis of early tracheostomy in patients with multiple rib fractures.Methods A retrospective case series study was conducted on medical data of 222 patients with multiple rib fractures who undenvent tracheostomy in Affiliated Hospital of Yangzhou University from February 2013 to October 2019,including 160 males and 66 females,with the age of 18 to 85 years[(49.5±16.3)years].According to the practice management guidelines for tracheostomy timing and the use of propensity score matching technology,there were 118 patients with tracheostomy within 7 days of tracheal intubation(early group)and 104 patients with tracheostomy after 7 days of tracheal intubation(late group)before matching,and there were 87 patients in early group and 87 patients in late group after matching.Data were compared between groups including the gender,age,underlying disease,injury severity score(ISS),Glasgow coma score(GCS),number of fractured ribs,total number of rib fractures(NTRF),first rib fracture,flail chest,traumatic brain injury,combined injuries(spine,maxillofacial,sternum),acute respiratory distress syndrome(ARDS),volume fraction of pulmonary contusion(VPC),blood lactic acid(within 24 hours of admission),hemothorax,pneumothorax,mechanical ventilation time,duration of tracheostomy,time from tracheal intubation to incision,length of hospital stay,length of stay in ICU,closed thoracic drainage,number of fiberoptic bronchoscopy,multi-drug resistant bacteria infection,ventilator-associated pneumonia,antibiotic use time,duration of sedative and analgesic drugs used and 28-day mortality.The multivariate Logistic regression analysis was used to predict independent risk factors for early tracheostomy.The Pearson method was used to compare the relationship between multiple factors.The receiver operating characteristic(ROC)curve was used to predict indicators that affect the prognosis of patients with early tracheostomy,and calculate the best cut-off value.The Kaplan-Mei

关 键 词：肋骨骨折 气管切开术 预后 

分 类 号：R683.1[医药卫生—骨科学]