腹部创伤后发生脓毒症的危险因素  

Risk factors for sepsis after abdominal trauma

作　　者：刘昕炜 胡时栋[1] 达布西力特 杜晓辉[1] LIU Xinwei;HU Shidong;DA Buxilite;DU Xiaohui(Department of General Surgery,the First Medical Center of PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心普通外科医学部,北京100853

出　　处：《武警医学》2024年第12期1013-1017,1023,共6页Medical Journal of the Chinese People's Armed Police Force

基　　金：军队某课题资助

摘　　要：目的 探讨腹部创伤后患者发生脓毒症的危险因素,为腹部创伤的临床治疗提供科学依据。方法 选用美国重症监护医学信息数据库Ⅳ(MIMIC-Ⅳ)回顾性分析273例腹部创伤患者的临床资料,包括入院时的伤情信息、危重症评分、生命体征、主要实验室检查结果和临床治疗情况,采用单因素筛选,多因素logistic回归分析腹部创伤后发生脓毒症的危险因素。结果 logistic多元回归分析显示,腹部手术(OR=3.249,95%CI:1.525~6.918,P=0.002)、机械通气(OR=4.684,95%CI:2.262~9.699,P<0.001)、钙(OR=0.610,95%CI:0.446~0.836,P=0.002)、全身炎症反应综合征评分(SIRS)(OR=1.993,95%CI:1.280~3.104,P=0.002)、中心静脉导管(OR=2.438,95%CI:1.068~5.561,P=0.034)是腹部创伤后发生脓毒症的独立危险因素。结论 腹部创伤后发生脓毒症与腹部手术、机械通气、钙离子水平、SIRS评分、中心静脉导管密切相关,临床中应注意及时评估腹部创伤患者发生脓毒症的风险,并做好监测和预防。Objective To explore the risk factors for sepsis in patients with abdominal trauma and to provide scientific basis for the clinical treatment of abdominal trauma.Methods The clinical data of 273 patients with abdominal trauma were retrospectively analyzed using the MIMIC-Ⅳdatabase,including the injury information at admission,severity scores,vital signs,major laboratory test results,and clinical treatment.Single-factor screening and multivariate logistic regression analysis were used to analyze the risk factors for sepsis after abdominal trauma.Results Logistic multiple regression analysis showed that surgical operation(OR=3.249,95%CI:1.525-6.918,P=0.002),mechanical ventilation(OR=4.684,95%CI:2.262-9.699,P<0.001),calcium(OR=0.610,95%CI:0.446-0.836,P=0.002),SIRS score(OR=1.993,95%CI:1.280-3.104,P=0.002),and central venous catheterization(OR=2.438,95%CI:1.068-5.561,P=0.034)were independent risk factors for sepsis after abdominal trauma.Conclusions The occurrence of sepsis after abdominal trauma is closely related to surgical operation,mechanical ventilation,calcium,SIRS score,and central venous catheterization.In clinical practice,attention should be paid to timely evaluation of the risk of sepsis in patients with abdominal trauma,and monitoring and prevention should be implemented accordingly.

关 键 词：腹部损伤 脓毒症 危险因素 预后 外科手术 

分 类 号：R641[医药卫生—外科学]