多发伤患者发生迟发性胸腔积液的相关危险因素分析  

Analysis of risk factors related to delayed pleural effusion in multiple trauma patients

作　　者：胡丽勤 石翠翠[2] 刘雄 谢柯 路鑫[1] 徐峰[1] 杨鹏[1] 陈雄辉[1] Hu Liqin;Shi Cuicui;Liu Xiong;Xie Ke;Lu Xin;Xu Feng;Yang Peng;Chen Xionghui(Emergency Department,First Affiliated Hospital of Soochow University,Institute of Traumatology,Soochow University,Jiangsu Provincial Innovation Center of Traumatology,Suzhou 215026,China;Department of Health Science,Soochow University School Clinic,Suzhou 215026,China)

机构地区：[1]苏州大学附属第一医院急诊科,苏州大学创伤医学研究所,江苏省创伤医学创新中心,苏州215026 [2]苏州大学校医院保健科,苏州215026

出　　处：《中华创伤杂志》2024年第10期897-902,共6页Chinese Journal of Trauma

基　　金：江苏省科教能力提升工程,江苏省医学创新中心(CXZX202231);苏州市基础研究专项项目(原创探索专项面上项目)(SSD2024050)。

摘　　要：目的探讨多发伤患者发生迟发性胸腔积液的相关危险因素。方法采用回顾性队列研究分析2022年1月至2023年10月苏州大学附属第一医院收治的145例多发伤患者的临床资料,其中男99例,女46例;年龄18~81岁[56.0(46.5,64.5)岁]。依据伤后是否发生迟发性胸腔积液,分为迟发性胸腔积液组(66例)和非迟发性胸腔积液组(79例)。收集两组患者的临床资料,包括性别、年龄、基础疾病(糖尿病、高血压)、致伤原因(交通伤、击打伤、高处坠落伤、其他)、合并伤(脑外伤、颌面部骨折、锁骨骨折、肩胛骨骨折、胸骨骨折、脊柱骨折、多发肋骨骨折、气胸、肺挫伤、骨盆骨折)、损伤严重程度[损伤严重度评分(ISS)、胸部简明损伤定级标准(AIS)评分]、肋骨骨折位置和数量、入院时生命体征(体温、心率、呼吸、收缩压、舒张压)及临床检验指标[白细胞(WBC)、血红蛋白(Hb)、血小板(PLT)、总蛋白(TP)、白蛋白(ALB)、C-反应蛋白(CRP)、降钙素原(PCT)、纤维蛋白原(FIB)、纤维蛋白降解产物(FDP)、D-二聚体(D-D)、谷草转氨酶(AST)、谷丙转氨酶(ALT)、肌酐(Cr)]等。采用单因素分析评估上述各因素与多发伤患者发生迟发性胸腔积液的相关性。采用多因素Logistic回归分析确定多发伤患者发生迟发性胸腔积液的独立危险因素。结果单因素分析结果表明,多发肋骨骨折、气胸、肺挫伤、胸部AIS评分、后肋骨折、肋骨骨折数量、TP、ALB、CRP、PCT、FDP与多发伤患者发生迟发性胸腔积液有一定相关性(P<0.05或0.01);而性别、年龄、基础疾病、致伤原因、胸骨骨折、脊柱骨折、锁骨骨折、肩胛骨骨折、骨盆骨折、颌面部骨折、脑外伤、前肋骨折、ISS、入院时生命体征、WBC、Hb、PLT、FIB、D-D、AST、ALT、Cr与多发伤患者发生迟发性胸腔积液不相关(P>0.05)。多因素Logistic回归分析结果表明,肺挫伤(OR=3.96,95%CI 1.59,9.85,P<0.01)、Objective To explore the risk factors related to delayed pleural effusion in multiple trauma patients.Methods A retrospective cohort study was conducted to analyze the clinical data of 145 multiple trauma patients admitted to the First Affiliated Hospital of Soochow University from January 2022 to October 2023,including 99 males and 46 females,aged 18-81 years[56.0(46.5,64.5)years].Based on whether delayed pleural effusion developed after injury,the patients were divided into delayed pleural effusion group(n=66)and non-delayed pleural effusion group(n=79).The clinical data of the patients in both groups were collected,including gender,age,underlying disease(diabetes mellitus and hypertension),cause of injury(traffic injury,blow injury,fall from height,and others),comorbid injuries(traumatic brain injury,maxillofacial fracture,clavicular fracture,scapular fracture,sternal fracture,spinal fracture,multiple rib fracture,pneumothorax,lung contusion,and pelvic fracture),severity of injury[injury severity score(ISS)and abbreviated injury scale(AIS)score for the chest],location and number of rib fractures,vital signs at admission(body temperature,heart rate,respiration,systolic blood pressure,diastolic blood pressure),and clinical test indices[white blood cells(WBC),hemoglobin(Hb),platelets(PLT),total protein(TP),albumin(ALB),C-reactive protein(CRP),procalcitonin(PCT),fibrinogen(FIB),fibrin degradation product(FDP),D-dimer(D-D),aspartate transaminase(AST),alanine transferase(ALT),and creatinine(Cr)].Univariate analysis was conducted to assess the correlation between the forementioned factors and the development of delayed pleural effusion after multiple traumas.Multivariate Logistic regression analysis was used to determine the independent risk factors for the development of delayed pleural effusion after multiple traumas.Results The results of univariate analysis showed that multiple rib fracture,pneumothorax,pulmonary contusion,chest AIS score,posterior rib fracture,number of rib fractures,TP,ALB,CRP,PCT and FDP were

关 键 词：创伤和损伤 胸腔积液 危险因素 

分 类 号：R641[医药卫生—外科学]