急性骨筋膜间隔综合征患者肌肉坏死的危险因素分析  

Risk factors of muscle necrosis in patients with acute compartment syndrome

作　　者：何凌霄[1] 陈琪[1] 张欢[1] 廖灯彬[1] 侯晓玲[1] 蒋艳[2] He Lingxiao;Chen Qi;Zhang Huan;Liao Dengbin;Hou Xiaoling;Jiang Yan(Trauma Center,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Nursing,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院创伤医学中心,成都610041 [2]四川大学华西医院护理部,成都610041

出　　处：《中华创伤杂志》2021年第12期1068-1073,共6页Chinese Journal of Trauma

摘　　要：目的探讨急性骨筋膜间隔综合征(ACS)患者发生肌肉坏死的危险因素。方法采用回顾性病例对照研究分析2010年1月至2020年12月四川大学华西医院收治的111例ACS患者临床资料,其中男84例,女27例;年龄18~76岁[45(36,55)岁]。发生肌肉坏死35例(肌肉坏死组),未发生肌肉坏死76例(无肌肉坏死组)。通过单因素分析比较两组患者的基本资料(性别、年龄、民族、体重指数、吸烟史、慢性合并症)、损伤情况[致伤机制(低能量损伤、高能量损伤、挤压伤、其他机制损伤)、受伤至就诊时间、是否首次就诊、是否伴有骨折、是否为开放性损伤、是否存在张力性水疱]、治疗情况(局部清创次数、是否行筋膜切开减压)和检验指标[血红蛋白(Hb)、血小板计数(PLT)、白细胞计数(WBC)、凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、白蛋白(ALB)、静脉血糖(GLU)、肌酸激酶(CK)、住院期间CK最高值(自然对数转换,lnCK)、血清钠(NA)、血清钾(K)、血清钙(CA)],进一步通过多因素Logistic回归分析,明确ACS患者肌肉坏死的独立危险因素。结果单因素分析结果显示,两组致伤机制、是否首次就诊、是否伴有骨折、局部清创次数、Hb、PT、INR、D-D、AST、ALB、GLU、CK、lnCK差异有统计学意义(P<0.05),两组基本资料、受伤至就诊时间、是否为开放性损伤、是否存在张力性水疱、是否行筋膜切开减压、PLT、WBC、APTT、FIB、ALT、NA、K、CA差异无统计学意义(P>0.05)。多因素Logistic回归分析结果表明,高能量损伤(OR=5.143,95%CI 1.216~21.758,P<0.05)、挤压伤(OR=22.313,95%CI 2.625~189.635,P<0.05)、其他机制损伤(OR=9.019,95%CI 1.036~78.554,P<0.05)、是否首次就诊(OR=0.071,95%CI 0.006~0.819,P<0.05)、Hb(OR=0.979,95%CI 0.961~0.998,P<0.05)、GLU(OR=1.218,95%CI 1.020~1.455,P<0.05)和lnCK(OR=1.80Objective To investigate the risk factors of muscle necrosis in patients with acute compartment syndrome(ACS).Methods A retrospective case-control study was conducted for clinical data of 111 ACS patients admitted to West China Hospital,Sichuan University from January 2010 to December 2020,including 84 males and 27 females;age 18-76 years[45(36,55)years].Muscle necrosis was presented in 35 patients(necrotic muscle group),but was not seen in 76 patients(non-necrotic muscle group).The univariate analysis was performed for the two groups in the demographic data(sex,age,ethnicity,body mass index,smoking history,chronic comorbidities),injury patterns[mechianism of injury(low energy injury,high energy injury,crush injury,other injury),time from injury to treatment,first visit or not,combination with bone fracture or not,open injury or not,presence of tension blisters or not],medical treatment(number of debridements,fasciotomy or not)and laboratory indicators[hemoglobin(Hb),platelet count(PLT),white blood cell count(WBC),prothrombin time(PT),international normalized ratio(INR),partially activated prothrombin time(APTT),fibrinogen(FIB),D-Dimer(D-D),alanine aminotransferase(ALT),aspartate aminotransferase(AST),albumin(ALB),intravenous blood glucose(GLU),creatine kinase(CK),peak value of CK during hospitalization(natural logarithmic conversion,lnCK),serum sodium(NA),serum potassium(K),serum calcium(CA)].Further multivariate logistic regression was performed to analyze the independent risk factors of muscle necrosis in ACS patients.Results The univariate analysis showed that there were statistically significant differences between the two groups in the mechanism of injury,first visit or not,combination with bone fracture or not,number of debridements,Hb,PT,INR,D-D,AST,ALB,GLU,CK and lnCK(P<0.05),while not in the basic data,time from injury to treatment,open injury or not,presence of tension blisters or not,fasciotomy or not,PLT,WBC,APTT,FIB,ALT,NA,K and CA(P>0.05).The multivariate logistic regression analysis showed that hi

关 键 词：软组织损伤 坏死 危险因素 筋膜室综合征 

分 类 号：R686[医药卫生—骨科学] R685[医药卫生—外科学]