ICU创伤大输血后老年与非老年患者预后的比较  

Comparison of prognosis between elderly and non⁃elderly patients with massive transfusion after trauma in ICU

作　　者：刘月高[1] 陆健[1] 张晓燕[1] 朱晶[2] 田锐[1] 周志刚[1] 谭小雪 王春光[1] 葛芳侠 邓会标 Liu Yuegao;Lu Jian;Zhang Xiaoyan;Zhu Jing;Tian Rui;Zhou Zhigang;Tan Xiaoxue;Wang Chunguang;Ge Fangxia;Deng Huibiao(Intensive Care Unit,Shanghai First People's Hospital Affiliated to Shanghai Jiaotong University,Shanghai,201620,P.R.China;Department of Blood Transfusion,Shanghai First People's Hospital Affiliated to Shanghai Jiaotong University,Shanghai,201620,P.R.China;Shanghai Panoramic Medical Imaging Diagnosis Center,Shanghai,200233,P.R.China)

机构地区：[1]上海交通大学附属第一人民医院危重病科,上海201620 [2]上海交通大学附属第一人民医院输血科,上海201620 [3]上海全景医学影像诊断中心,上海200233

出　　处：《老年医学与保健》2023年第2期256-260,共5页Geriatrics & Health Care

基　　金：上海申康医院发展中心临床科技创新项目(SHDC22021211)。

摘　　要：目的 探讨老年对ICU创伤大量输血患者预后的影响。方法 回顾性分析2006年11月—2021年12月入住上海交通大学附属第一人民医院ICU的严重创伤大输血患者。所有分类变量采用卡方检验或Fisher精确检验,连续变量采用独立样本t检验或非参数检验,采用Logistic回归分析校正混杂因素,通过K-M生存曲线分析判断患者的预后。结果 最终有268例患者纳入研究。根据年龄把患者分成观察组(年龄≥60岁)和对照组(年龄<60岁)。2组患者性别比例、入院生命体征及严重度评分对比分析差异无统计学意义。2组在浓缩红细胞、新鲜冰冻血浆、冷沉淀输注量及入院当天的输液总量对比差异无统计学意义。2组患者的肝肾功能、凝血功能对比分析差异无统计学意义。观察组患者的住院中位时间为27.0 d,住ICU中位时间为9.0 d,对照组患者的住院中位时间为21.0 d,住ICU中位时间为9.0 d。入院28 d,观察组患者中死亡17例(43.6%),对照组中死亡68例(29.7%),2组差异没有统计学意义(P=0.074)。结论 老年创伤大输血患者并不多见,受伤机制相对单一,与年轻人相比,在没有严重合并症的干扰下,即使≥60岁老年人在遭遇严重的创伤时,死亡率并没有显著升高。Objective To explore the influence of aging on the prognosis of ICU patients with massive transfusion after trauma.Methods A retrospective study was performed on patients with massive transfusion after trauma admitted to ICU of Shanghai First People􀆳s Hospital Affiliated to Shanghai Jiaotong University from November 2006 to December 2021.Chi⁃square test or Fisher exact test were used for all categorical variables,and independent sample t⁃test or nonparametric test were used for continuous variables.The confounding factors were corrected by logistic regression analysis.The prognosis of patients was de⁃termined by K⁃M survival curve analysis.Results Finally,268 patients were included in the study.They were divided into observation group(≥60 years old)and control group(<60 years old)according to age.There were no significant differences in gender ratio,vital signs and severity scores at admission between the two groups.There was no statistically significant differ⁃ence in the infusion amount of concentrated red blood cells,fresh frozen plasma,cryoprecipitate infusion,and the total amount of infusion on the day of admission between the two groups.There was no statistical difference in hepatic and renal function and coagulation function between the two groups.The median hospitalization time of the observation group was 27.0 days and the median hospitalization time in ICU was 9.0 days,while the median hospitalization time of the control group was 21.0 days and the median hospitalization time in ICU was 9.0 days.On 28 days after admission,17 patients(43.6%)in the observation group died,while 68 ones(29.7%)in the control group died,there was no statistical difference between the two groups(P=0.074).Conclusion Elderly patients with massive transfusion after trauma are rare,and the mechanism of injury is relatively simple.In the absence of severe comorbidities,mortality was not significantly higher in people older than 60 years of age who suffered severe trauma compared with younger people.

关 键 词：创伤 老年 大输血 预后 

分 类 号：R457.1[医药卫生—治疗学] R641[医药卫生—临床医学]