CAJ | 학술논문

目的探讨多发伤并发急性肺损伤的影响因素，为早期干预急性肺损伤提供理论依据。方法将2006年3月至2011年3月在该院急诊科多发伤患者分为研究组和对照组，所有入组病例均进行损伤严重度评分（ISS ），急性生理学和慢性健康状况Ⅱ（APACHEⅡ）评分，记录吸烟、饮酒、糖尿病史、器官损伤数目、消化道出血、肺挫裂伤、弥散性血管内凝血（DIC）、呕吐、创伤性休克、休克纠正时间、输血量。选择血管紧张素转换酶（ACE）基因SNP位点rs3788853、rs13306087、rs12709426作多态性分析。结果研究组和治疗组ISS、APACHEⅡ评分、输血量、DIC、创伤性休克、休克纠正时间超过6 h 6种影响因素的差异有统计学意义（P＜0．05）；两组间ACE基因的基因频率和基因型频率差异均无统计学意义（P＞0．05）；Logistic回归分析6种影响因素均是研究组的危险因素。结论 ISS、APACHEⅡ评分、输血量、DIC、创伤性休克、休克纠正时间过长等因素是多发伤并发急性肺损伤的危险因素。
목적탐토다발상병발급성폐손상적영향인소，위조기간예급성폐손상제공이론의거。방법장2006년3월지2011년3월재해원급진과다발상환자분위연구조화대조조，소유입조병례균진행손상엄중도평분（ISS ），급성생이학화만성건강상황Ⅱ（APACHEⅡ）평분，기록흡연、음주、당뇨병사、기관손상수목、소화도출혈、폐좌렬상、미산성혈관내응혈（DIC）、구토、창상성휴극、휴극규정시간、수혈량。선택혈관긴장소전환매（ACE）기인SNP위점rs3788853、rs13306087、rs12709426작다태성분석。결과연구조화치료조ISS、APACHEⅡ평분、수혈량、DIC、창상성휴극、휴극규정시간초과6 h 6충영향인소적차이유통계학의의（P＜0．05）；량조간ACE기인적기인빈솔화기인형빈솔차이균무통계학의의（P＞0．05）；Logistic회귀분석6충영향인소균시연구조적위험인소。결론 ISS、APACHEⅡ평분、수혈량、DIC、창상성휴극、휴극규정시간과장등인소시다발상병발급성폐손상적위험인소。
Objective To investigate the risk factors to acute lung injury based on multiple trauma to provide a theoretical basis for early intervention .Methods The emergency surgical patients with multiple trauma in our hospital from March 2006 to March 2011 were selected .The patients meeting the diagnostic criteria for acute lung injury were taken as the study group and the others as the control group .All patients were enrolled for evaluating the injury severity score (ISS) ,acute physiology and chronic health Ⅱ(APACHE Ⅱ) score and recording smoking ,alcohol abuse ,diabetes mellitus ,number of organ damage ,gastrointestinal bleeding , pulmonary contusion ,diffuse intravascular coagulation (DIC ) ,vomiting ,traumatic shock ,time to correct shock ,blood transfusion . The polymorphism of rs3788853 ,rs13306087 ,rs12709426 of angiotensin-converting enzyme(ACE) gene were analyzed .Results In the study group and the control group ,there were statistical differences in 6 influencing factors of the ISS ,APACHE Ⅱ score ,blood transfusion ,DIC ,traumatic shock ,time to correct shock>6 h(P<0 .05);the gene and genotype frequencies of ACE between the two groups had no statistical difference (P>0 .05);the 6 kinds of influencing factors were risk to acute lung injury based on multi-ple trauma by Logistic regression analysis .Conclusion The ISS ,APACHE Ⅱ score ,blood transfusion ,DIC ,traumatic shock ,long time to correct shock are the risk factors to acute lung injury based on multiple trauma .