CAJ | 학술논문

目的研究影响严重创伤合并急性肺损伤患者病死率的潜在危险因素.方法这是一项以严重创伤作为唯一原因收治急诊科和急诊监护室患者的回顾性病例对照研究,通过单因素和多因素逻辑回归分析法对18个潜在影响严重创伤病死率的危险因素进行分析.结果有343例严重创伤合并创伤后急性肺损伤患者收治于急诊科和急诊监护室,分析得出五个影响急性肺损伤病死率的危险因素是:(1)急性生理和慢性健康状况评分(acute physiology and chronic health evaluation,A-PACHE)Ⅱ评分,(2)创伤持续时间,(3)年龄,(4)胃肠返流,和(5)弥散性血管内凝血(disseminated intravascular coagulation,DIC),亦发现这些特定的危险因素对不同的分层患者人群具有不同的影响程度.结论 APACHEⅡ评分和胃肠返流对急性肺损伤病死率的影响在创伤后的早期阶段.值得注意的是创伤持续时间和DIC对急性肺损伤的进展和病死率既有短期影响,又有远期影响.老龄患者(大于65岁)由于继发脓毒症和肺功能的恶化仍旧是影响病死率的独立危险因素.具备以上危险因素的患者应尽可能早的接受积极的支持治疗以阻止病情的恶化.
목적 연구영향엄중창상합병급성폐손상환자병사솔적잠재위험인소.방법 저시일항이엄중창상작위유일원인수치급진과화급진감호실환자적회고성병례대조연구,통과단인소화다인소라집회귀분석법대18개잠재영향엄중창상병사솔적위험인소진행분석.결과 유343례엄중창상합병창상후급성폐손상환자수치우급진과화급진감호실,분석득출오개영향급성폐손상병사솔적위험인소시:(1)급성생리화만성건강상황평분(acute physiology and chronic health evaluation,A-PACHE)Ⅱ평분,(2)창상지속시간,(3)년령,(4)위장반류,화(5)미산성혈관내응혈(disseminated intravascular coagulation,DIC),역발현저사특정적위험인소대불동적분층환자인군구유불동적영향정도.결론 APACHEⅡ평분화위장반류대급성폐손상병사솔적영향재창상후적조기계단.치득주의적시창상지속시간화DIC대급성폐손상적진전화병사솔기유단기영향,우유원기영향.노령환자(대우65세)유우계발농독증화폐공능적악화잉구시영향병사솔적독립위험인소.구비이상위험인소적환자응진가능조적접수적겁적지지치료이조지병정적악화.
Objective To identify the potential risk factors affecting mortality rate of ALl in severe trauma population. Method It was a retrospective cohort study treating trauma as a single cause for emergency depart-ment (ED)) and emergency intensive care unit (EICU) admissions. Eighteen potential risk factors affecting the mortality of ALI were examined by univariate and multivariate logistic analyses in these severe trauma patients. Re-sults There were 343 severe trauma patients with post-traumatic ALI admitted to ED and EICU the Second Affili-ated Hospital Medical College,Zhejiang University,during the study period. The five risk factors that affected the mortality with unadjusted odd ratios (ORs) and 95% confidence intervals (CIs) were (1) APACHE Ⅱ score, (2)duration of trauma, (3) age, (4) aspiration of gastric contents, and (5) DIC. Specific risk factors also affected different patients subpepulations at different degrees. Conclusions Factors of APACHE Ⅱ score and aspiration of gastric contents that can predict the mortality of ALl may exist in the early stage of trauma. Duration of trauma and DIC that greatly affect the short- and long-term development of ALI deserve special attention. Elderly patients (aged beyond 65 years) are the independent risk factor for the secondary sepsis and deterioration of pulmonary function. Patients with these risk factors need aggressive supportive care as early as possible in order to prevent fur-ther aggravation.