多发伤患者伤后早期多因型休克的临床研究  

Incidences and characteristics of multifactorial shock in polytrauma patients in the early phase afteRtrauma

作　　者：罗家柳 唐朝晖[1] 张聪 陈顺尧 林智强 陈登 常特定 徐化强 汪文国 殷刚[3] 董黎明 Luo Jialiu;Tang Zhaohui;Zhang Cong;Chen Shunyao;Lin Zhiqiang;Chen Deng;Chang Teding;Xu Huaqiang;Wang Wenguo;Yin Gang;Dong Liming(Department of Traumatic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Intensive Care Unit,Suizhou Central Hospital,Hubei University of Medicine,Suizhou,Hubei Province 441300,China;Department of Traumatic Surgery,Tianmen First People’s Hospital,Hubei University of Science and Technology,Tianmen,Hubei Province 417300,China)

机构地区：[1]华中科技大学同济医学院附属同济医院创伤外科,武汉430030 [2]随州市中心医院,湖北医药学院附属随州医院重症医学科,湖北随州441300 [3]天门市第一人民医院创伤外科,湖北天门417300

出　　处：《创伤外科杂志》2024年第8期579-585,共7页Journal of Traumatic Surgery

基　　金：国家自然科学基金(81873870)。

摘　　要：目的 研究多发伤患者在伤后早期多因型休克的发生情况及特征。方法 回顾性分析2020年6月-2023年3月收治于3家创伤中心的多发伤患者1 493例。收集入组患者住院期间相关资料、临床表现、实验室检验、影像学检查、并发症发生情况等,依据各休克类型的诊断标准,观察多发伤患者伤后早期多因型休克的发生情况及特征。通过t检验或χ2检验比较组间差异。结果 入组多发伤患者ISS为(24.52±7.28)分。69.86%(1043/1493,95%CI:67.5%~72.2%)的多发伤患者伴发休克,其中单因型休克占比90.89%(948/1043,95%CI:89.1%~92.6%),多因型休克占比9.11%(95/1043,95%CI:7.4%~10.9%)。共观察到6种不同病因组合的多因型休克,分别为低血容量性休克(HS)+分布性休克(DS),HS+梗阻性休克(OS),HS+心源性休克(CS),OS+CS,HS+DS+OS,HS+DS+CS,分别占41.05%、23.16%、14.74%、3.16%、11.58%、6.32%。与单因型休克患者相比,多因型休克患者的机械通气比例(77.89%vs. 34.60%)、血管活性药物使用比例(87.37%vs. 58.86%)、ICU住院时间[(15.7±6.5)dvs.(7.2±3.1)d]、病死率(37.89%vs. 9.60%)显著更多,P均<0.01。结论 多发伤患者伴发多因型休克并不罕见,该类患者伤情危重、预后不佳、病死率高。Objective To assess the incidences and clinical characteristics of multifactorial shock in the early phase afteRpolytrauma.Methods Totally 1493 patients with polytrauma admitted to ouR3 multiple trauma centers from Jun.2020 to Mar.2023 were enrolled.Inclusion criteria were age≥18 years and meeting the new Berlin definition of polytrauma.Patients’medical records,clinical manifestations,laboratory tests,imaging exams,and complications were collected.According to the diagnostic criteria foReach type of shock,the incidences and clinical characteristics of multifactorial shock in the early phase afteRpolytrauma were analyzed.The differences between the groups were compared by Student’s[WTBX]t-test,oRchi-square test.Results The ISS of the enrolled polytrauma patients was 24.52±7.28.Among the 1493 polytrauma patients,1043(69.86%,95%CI:67.5%-72.2%)were accompanied by shock,with single-factoRshock accounting foR90.89%(948/1043,95%CI:89.1%-92.6%)and multifactorial shock accounting foR9.11%(95/1043,95%CI:7.4%-10.9%).In total,six combinations of multifactorial shock were observed,respectively hypovolemic shock(HS)+distributed shock(DS),HS+obstructive shock(OS),HS+cardiogenic shock(CS),OS+CS,HS+DS+OS,and HS+DS+CS,accouting foR41.05%,23.16%,14.74%,3.16%,11.58%,6.32%,respectively.Compared to patients with single-factoRshock,patients with multifactorial shock had significantly higheRrates of mechanical ventilation(77.89%vs.34.60%),more use of vasoactive agents(87.37%vs.58.86%),longeRICU length of stay(d,15.7±6.5 vs.7.2±3.1),and higheRmortality(37.89%vs.9.60%,all P<0.01).Conclusion Multifactorial shock is not uncommon in polytrauma patients in the early phase afteRtrauma.These patients are critically injured and have a relatively pooRoutcome and high mortality.

关 键 词：多发伤 休克 多因型休克 

分 类 号：R605.971[医药卫生—急诊医学]