老年多发伤患者短期内并发多器官功能障碍综合征的危险因素分析  

Risk factors analysis of multiple organ dysfunction syndrome in elderly patients with multiple injuries in shortterm

作　　者：梁亚鹏[1] 尹其翔[1] 周峰[1] 苗振军[1] 蔡华忠[1] 贾珏[1] 徐美玲 LIANG Yapeng;YIN Qixiang;ZHOU Feng;MIAO Zhenjun;CAI Huazhong;JIA Jue;XU Meiling(Emergency Department,The Affiliated Hospital of Jiangsu University,Zhenjiang 212001,Jiangsu,China;General Department,Zhenjiang Jingkou Jiankang Road Community Health Service Center,Zhenjiang 212001,Jiangsu,China)

机构地区：[1]江苏大学附属医院急诊科,江苏镇江212001 [2]镇江市京口区健康路社区卫生服务中心全科,江苏镇江212001

出　　处：《西部医学》2022年第11期1630-1634,共5页Medical Journal of West China

基　　金：国家自然科学基金项目(81500351);镇江市重点研发计划-社会发展项目(SH2020067)。

摘　　要：目的 探讨影响老年多发伤患者短期内并发多器官功能障碍综合征(MODS)的危险因素。方法 回顾性分析2010年11月~2020年8月江苏大学附属医院收治的130例老年多发伤患者的临床资料,根据患者是否在入院4周内并发MODS分为MODS组(n=42)和非MODS组(n=88)。比较两组性别、年龄、致伤原因、入院前时间、损伤部位数目、主要损伤部位、损伤严重度评分(ISS)、D-二聚体水平、动脉血乳酸水平、急性生理与慢性健康状况(APACHEIII)评分、是否急诊手术、是否输血和是否合并脓毒症等13个临床指标。通过单因素分析和多因素Logistic回归分析探讨影响老年多发伤患者短期内并发MODS的危险因素。结果 单因素分析显示主要损伤部位、ISS、D-二聚体水平、动脉血乳酸水平、APACHEIII评分、是否急诊手术和是否合并脓毒症共7个临床指标在两组间比较有统计学差异(P<0.05),而性别、年龄、致伤原因、入院前时间、损伤部位数目和是否输血共6个临床指标在两组间比较无统计学差异(P>0.05)。多因素Logistic回归分析显示主要损伤部位、ISS、D-二聚体水平、动脉血乳酸水平、APACHEIII评分和是否合并脓毒症共6个临床指标是影响老年多发伤患者短期内并发MODS的独立危险因素(P<0.05)。结论 影响老年多发伤患者短期内并发MODS的独立危险因素包括主要损伤部位、ISS、D-二聚体水平、动脉血乳酸水平、APACHEIII评分和是否合并脓毒症。重视主要损伤部位、损伤严重程度、凝血功能和综合病情危重程度的评估,同时有效液体复苏,改善微循环及维护内环境稳定并预防感染可降低老年多发伤患者短期内并发MODS的风险。Objective Clinical data of elderly patients with multiple injuries were reviewed and analyzed to explore the risk factors affecting multiple organ dysfunction syndrome(MODS) in elderly patients with multiple injuries in shortterm. Methods The clinical data of 130 elderly patients with multiple injuries from November 2010 to August 2020 were retrospectively analyzed, including 13 clinical indexes, such as sex, age, cause of injury, time before admission, number of injury sites, major injury site, Injury Severity Score(ISS), D-dimer level, lactic acid level in arterial blood, Acute Physiology and Chronic Health Evaluation III(APACHEIII) score, whether with emergency surgery, blood transfusion and sepsis. The risk factors of multiple organ dysfunction syndrome in elderly patients with multiple injuries in shortterm were determined by uni-variate and multivariate logistic regression analysis. Results According to whether the patient complicated with multiple organ dysfunction syndrome after admission within 4 weeks, the 130 elderly patients with multiple injuries were divided into MODS group(n=42) and non MODS group(n=88). Uni-variate analysis showed significant difference(P<0.05) between the two groups in seven clinical parameters, including major injury site, ISS, D-dimer level, lactic acid level in arterial blood, APACHEIII score, whether with emergency surgery and sepsis. However, there was no significant difference(P>0.05) between the two groups in six clinical parameters, including sex, age, cause of injury, time before admission, number of injury sites and whether with blood transfusion. Multivariate logistic regression analysis indicated that major injury site, ISS, D-dimer level, lactic acid level in arterial blood, APACHEIII score and whether with sepsis were independent risk factors for MODS in elderly patients with multiple injuries in shortterm(P<0.05). Conclusion The independent risk factors for short-term MODS in elderly patients with multiple injuries included major injury site, ISS, D-dimer level, la

关 键 词：老年 多发伤 短期 多器官功能障碍综合征 危险因素 

分 类 号：R459.7[医药卫生—急诊医学]