多发性创伤后黄疸的发生、预后及危险因素分析  

Incidence,prognosis and risk factors of jaundice in polytrauma patients

作　　者：唐良晟 董黎明 陈登 张聪 罗家柳 陈顺尧 林智强 张沛东 常特定 唐朝晖[2,3] Tang Liangsheng;Dong Liming;Chen Deng;Zhang Cong;Luo Jialiu;Chen Shunyao;Lin Zhiqiang;Zhang Peidong;Chang Teding;Tang Zhaohui(Jianli Trauma Center,Department of Orthopaedic Surgery,Jianli People's Hospital,Jianli 433300,China;Tongji Trauma Center,Department of Trauma Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Emergency and Critical Care Medicine,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030 China)

机构地区：[1]监利市创伤中心,监利市人民医院骨外科,监利433300 [2]同济创伤中心,华中科技大学同济医学院附属同济医院创伤外科,武汉430030 [3]华中科技大学同济医学院附属同济医院急诊与重症医学科,武汉430030

出　　处：《中华急诊医学杂志》2024年第5期630-635,共6页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金(81873870)。

摘　　要：目的研究多发性创伤患者伤后黄疸的发生情况、预后及可能的早期高危因素。方法本研究为单中心、前瞻性研究,同济医院创伤中心2020年10月至2023年1月期间收治的年龄>18岁的多发伤患者,排除伴发肝、胆道或胰腺外伤,以及既往慢性肝脏病史等。收集患者临床资料,实验室检验结果、影像学检查结果及损伤严重度评分(injury severity score,ISS)、格拉斯哥昏迷评分及急性生理与慢性健康评分等。分析多发伤后黄疸发生率、黄疸分类、伴黄疸患者的病死率,以及伤后早期黄疸的危险因素。采用t检验或χ^(2)检验比较各指标的组间差异,Logistic回归分析黄疸发生的相关危险因素。结果本研究纳入多发性创伤患者742例,34.09%多发伤患者伤后伴发黄疸,且中度与重度黄疸的比率高达32.41%,黄疸的主要类型为肝内胆汁淤积性黄疸(47.03%)。伴黄疸的多发伤患者病死率高于不伴黄疸多发伤患者(12.25%vs.3.47%,P<0.001)。经Logistic回归分析发现,ISS评分(OR=3.405,95%CI:1.962~7.438,P=0.026)、血乳酸(OR=2.216,95%CI:1.203~4.862,P=0.017)、白介素6水平(OR=2.431,95%CI:1.424~3.793,P=0.007)、肠外营养支持时间(OR=3.011,95%CI:1.624~5.041,P=0.022)与机械通气时长(OR=3.572,95%CI:1.497~4.601,P=0.031)为多发伤患者伤后早期伴发黄疸的独立危险因素。结论多发伤患者伤后易伴发黄疸,其危害较大,特别是对伤后肝内胆汁淤积性黄疸临床应予高度关注。应加强对伤后伴发黄疸的高风险因素的早期识别与早期干预。Objective To assess the occurrence,prognosis and possible early risk factors of jaundice in polytrauma patients.Methods This study was a single-center,prospective study.Polytrauma patients(age>18 years)admitted to Tongji Trauma Center from October 2020 to January 2023 were enrolled.The patients with liver,biliary tract or pancreatic traumatic injury,previously suffered from chronic liver disease were excluded.The clinical characteristics of patients,laboratory test results,imaging examination results,Injury Severity Score(ISS),Glasgow Coma Score and APACHEⅡscore were collected.The incidence of jaundice,the classification of jaundice or the severity of jaundice after multiple injuries,the mortality rate of polytrauma patients with jaundice,and the early independent risk factors of jaundice in polytrauma were analyzed.The differences between the groups were compared by Student’s t test orχ^(2)test.The independent risk factors of jaundice were analyzed by Logistic regression analyzed.Results A total of 742 polytrauma patients were included,34.09%polytrauma patients were accompanied by jaundice,and the ratio of both moderate and severe jaundice were as high as 32.41%.The main type of jaundice was intrahepatic cholestatic jaundice(47.03%).The mortality rate of polytrauma patients accompanied by jaundice was significantly higher than that of polytrauma patients without jaundice(12.25%vs.3.47%,P<0.001).Logistic regression analysis showed that ISS score(OR=3.405,95%CI:1.962-7.438,P=0.026),plasma lactate(OR=2.216,95%CI:1.203-4.862,P=0.017),interleukin-6 levels(OR=2.431,95%CI:1.424-3.793,P=0.007),the overall duration of parenteral nutrition(OR=3.011,95%CI:1.624-5.041,P=0.022),and the total duration of mechanical ventilation(OR=3.572,95%CI:1.497-4.601,P=0.031)were the early independent risk factors for jaundice in patients after polytrauma.Conclusions Polytrauma patients are prone to developing jaundice after injury,which is more harmful,especially for intrahepatic cholestatic jaundice after injury.Early identification

关 键 词：多发性创伤 黄疸 前瞻性研究 发生率 危险因素 

分 类 号：R641[医药卫生—外科学]