不同年龄严重创伤死亡患者的性别差异分析  

Analysis of sex differences in severe traumatic death patients of different ages

作　　者：章曙 许永安[1] 应健智 Zhang Shu;Xu Yong'an;Ying Jianzhi(Department of Emergency,The Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310000,Zhejiang Province,China;Department of Emergency,Taizhou First People's Hospital,Taizhou 318020,Zhejiang Province,China)

机构地区：[1]浙江大学医学院附属第二医院急诊科,杭州310000 [2]台州市第一人民医院急诊科,台州318020

出　　处：《中国基层医药》2023年第6期895-900,共6页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨不同年龄严重创伤死亡患者的性别差异。方法回顾性分析2017年6月至2022年6月浙江大学医学院附属第二医院和台州市第一人民医院诊治的408例严重创伤患者,根据年龄不同分为儿童组(≤14岁)47例,成年人组(>14~50岁)171例和老年组(>50岁)90例。使用多变量logistic回归评估三组患者基于性别的死亡率差异,非线性回归评估年龄和性别持续增加对预测生存率的双向交互作用。结果交通事故是成年人组男性死亡的最常见原因(58.93%,χ^(2)=7.95,P=0.027),跌倒是老年组男性死亡的最常见原因(57.36%,χ^(2)=8.63,P=0.001)。成年人和老年组女性患者损伤严重程度评分(ISS评分)明显高于男性[成年人组:男性(24.39±4.17)分,女性(26.32±4.31)分,t=2.84,P=0.005)。老年组男性患者创伤后并发症发生率较高(呼吸衰竭:男性28.68%,女性14.75%,χ^(2)=4.37,P=0.036;循环衰竭:男性27.13%,女性13.11%,χ^(2)=4.64,P=0.031;神经精神障碍:男性20.93%,女性8.20%,χ^(2)=4.79,P=0.029;呼吸感染:男性31.78%,女性18.03%,χ^(2)=5.55,P=0.047;其他感染疾病:男性28.68%,女性13.11%,χ^(2)=0.69,P=0.018)。对协变量调整后,老年组男性死亡率明显高于女性(OR:1.261,95%CI:1.185~1.343,P<0.001)。随着年龄的增长,不同性别创伤后的预测存活率也同样降低,>50岁男性的预测存活率下降更为明显(交互P=0.051)。钝性和严重头部创伤患者中,>50岁患者与年龄相关的死亡率下降与性别间具有强交互作用(交互P=0.002)。穿透性创伤患者中,不同性别的预测存活率具有微弱交互作用(交互P=0.192)。结论创伤后死亡率的年龄相关变化在不同性别之间差异无统计学意义,>50岁的人群中,男性患者有相对较高的死亡风险。Objective To investigate the sex differences in severe traumatic death patients of different ages.Methods A total of 408 patients with severe trauma who received treatment in The Second Affiliated Hospital of Zhejiang University School of Medicine and Taizhou First People's Hospital from June 2017 to June 2022 were retrospectively analyzed.These patients were divided into the children group(≤14 years old,n=47),the adult group(14-50 years old,n=171),and the older adult group(>50 years old,n=90).Multivariate logistic regression was used to evaluate the difference in sex-based mortality among the groups.Nonlinear regression was used to evaluate the mutual interaction of increasing age and sex on the predicted survival rate.Results Traffic accidents were the most common cause of death among men in the adult group(58.93%,χ^(2)=7.95,P=0.027).Falls were the most common cause of death among men in the older adult group(57.36%,χ^(2)=8.63,P=0.001).The Injury Severity Score of women in the adult and older adult groups was significantly higher in women than that of men in the same group[adult group:men:(24.39±4.17)points,women:(26.32±4.31)points,t=2.84,P=0.005).The incidence of post-traumatic complications in the older adult group was very higher in men than in women(respiratory failure:28.68%in men,14.75%in women,χ^(2)=4.37,P=0.036;circulatory failure:men:27.13%,women:13.11%,χ^(2)=4.64,P=0.031;neuropsychiatric disorders:men:20.93%,women:8.20%,χ^(2)=4.79,P=0.029;respiratory infection:men:31.78%,women:18.03%,χ^(2)=5.55,P=0.047;other infectious diseases:men:28.68%,women:13.11%,χ^(2)=0.69,P=0.018).After adjusting for covariates,the mortality rate of men in the older adult group was significantly higher than that of women in the same group(OR:1.261,95%CI:1.185-1.343,P<0.001).With the increase of age,the predicted survival rate after the trauma in patients of different sexes also decreased,in particular in men aged>50 years(interaction P=0.051).Among patients with blunt and severe head trauma,age-related mortality decl

关 键 词：创伤和损伤 年龄因素 性别因素 死亡率 损伤严重程度评分 预后 

分 类 号：R641[医药卫生—外科学]