多发肋骨骨折延长机械通气时间的多因素分析  

Multivariate analysis of prolonged mechanical ventilation in patients with multiple rib fracture

作　　者：李春林 黄刚[1] 张萌[1] 周志刚[1] 牛晓光[1] 张鑫[1] 李普[1] 胡洪伟 杨金良[1] Li Chunlin;Huang Gang;Zhang Meng;Zhou Zhigang;Niu Xiaoguang;Zhang Xin;Li Pu;Hu Hongwei;Yang Jinliang(Department of Thoracic Surgery,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院胸外科,石家庄050051

出　　处：《创伤外科杂志》2021年第9期650-654,共5页Journal of Traumatic Surgery

摘　　要：目的对于多发肋骨骨折使用机械通气的患者,分析延长机械通气时间的危险因素,为临床治疗方法提供理论依据或参考。方法回顾性分析2014年1月—2019年5月河北医科大学第三医院胸外科收治的多发肋骨骨折使用机械通气患者406例,排除合并重度颅脑损伤及脊髓损伤患者181例,共纳入225例,包括内固定手术患者119例,未手术患者106例,通过一般资料分析疾病谱的年龄、职业、致伤原因分布特点,统计分析病死率、胸部简明损伤评分(AIS)及损伤严重程度评分(ISS)特点,采用单因素分析及多元线性回归模型分析延长机械通气时间的危险因素。结果整体平均使用机械通气时间(5.80±6.53)d,分析结果显示接受手术患者AIS、ISS均显著高于未手术患者(P<0.05),而病死率虽无统计学差异,但整体比率略低,机械通气的使用时间与入院时心率、胸部AIS、头颈部AIS、ISS、美国创伤外科协会(AAST)评分呈相关性,ISS是多发肋骨骨折患者机械通气时间延长的危险因素(P<0.05),此外AAST评分、气管切开、肺部感染、脓毒症也增加了机械通气时间延长的风险(P<0.01)。结论ISS、AAST评分、肋骨骨折合并气管切开、肺部感染、脓毒症增加是多发肋骨骨折患者机械通气时间延长风险,入院后应尽早对患者进行ISS、AAST等评分评估全身伤情,对多发伤患者应及时行气管切开。Objective To analyze the risk factors of prolonged mechanical ventilation in patients with multiple rib fractures,so as to provide theoretical basis or reference for clinical treatment.Methods A total of 406 patients with multiple rib fractures treated by mechanical ventilation in the Department of Thoracic Surgery,the Third Hospital of Hebei Medical University from January.2014 to May 2019 were retrospectively analyzed.Totally 181 patients with severe craniocerebral injury and spinal cord injury were excluded.A total of 225 patients were included,including 119 patients with internal fixation and 106 patients without operation.The distribution characteristics of age,occupation and cause of injury of disease spectrum were analyzed by general data.The characteristics of mortality,chest injury score(AIS)and injury severity score(ISS)were statistically analyzed.The risk factors of prolonged mechanical ventilation were analyzed by univariate analysis and multiple linear regression model.Results The average duration of mechanical ventilation was(5.80±6.53)days.The analysis results showed that AIS and ISS of patients with surgery were significantly higher than those of patients without surgery(P<0.05),while the mortality rate was not statistically different,but the overall rate was slightly lower.The duration of mechanical ventilation was correlated with admission heart rate,chest AIS,head and neck AIS,ISS and AAST score.ISS was a risk factor for prolonged mechanical ventilation in patients with multiple rib fractures(P<0.05).In addition,AAST score,tracheotomy,pulmonary infection and sepsis also increased the risk of prolonged mechanical ventilation(P<0.01).Conclusion ISS,AAST score,rib fracture combined with tracheotomy,pulmonary infection and sepsis increase the risk of prolonged mechanical ventilation time in patients with multiple rib fractures.After admission,ISS and AAST should be performed as soon as possible to evaluate the general injury,and tracheotomy should be performed in time for patients with multiple in

关 键 词：肋骨骨折 机械通气 脓毒血症 评分 危险因素 

分 类 号：R641[医药卫生—外科学]