CAJ | 학술논문

目的探讨单中心老年创伤患者流行病学变化特点,为临床救治提供参考.方法筛选2007年1月-2014年12月收治的1 646例老年创伤患者(年龄≥65岁),其中男649例,女997例;年龄65 ～110岁,平均76.7岁.分析患者性别、年龄、致伤原因、致伤部位、损伤严重度评分(ISS)、病死率、死亡原因、伴发病、住院时间、住院费用等变化.比较引人损害控制技术和建立“急救绿色通道”前(2007-2009年组)和后(2010-2014年组)伤情变化及死亡组与生存组患者的特点. 结果老年创伤患者数量(t=7.31,P＜0.01)及其在总体创伤患者中所占比例(t=6.29,P＜0.01)均逐年上升,平均年龄逐年增加(t=3.11,P＜0.05),伴发病所得查尔森基础疾病权重指数(WIC)逐年增大(t=6.45,P＜0.01),病死率逐年下降(t=-4.27,P＜0.01),而平均ISS和ISS≥16分所占当年的比例均无明显变化(P＞0.05).跌倒伤是首位致伤原因,且逐年增加(t=2.83,P＜0.05).2010-2014年组平均ISS(t=2.13,P＜0.05)和ISS≥16分所占比例(x2=3.92,P＜0.05)均高于2007-2009年组,但其病死率却明显低于2007-2009年组(X2=4.33,P＜0.05).与非死亡组比较,死亡组患者年龄更大、损伤严重程度更重、伴随疾病情况也更严重,交通伤发生率更高(P均＜0.05). 结论随着创伤救治技术的改进和救治策略的完善,老年创伤患者病死率呈下降趋势.老年创伤患者的伴发病和致伤原因提示,应重点加强对老年患者创伤的预防.
목적 탐토단중심노년창상환자류행병학변화특점,위림상구치제공삼고.방법 사선2007년1월-2014년12월수치적1 646례노년창상환자(년령≥65세),기중남649례,녀997례;년령65 ～110세,평균76.7세.분석환자성별、년령、치상원인、치상부위、손상엄중도평분(ISS)、병사솔、사망원인、반발병、주원시간、주원비용등변화.비교인인손해공제기술화건립“급구록색통도”전(2007-2009년조)화후(2010-2014년조)상정변화급사망조여생존조환자적특점. 결과 노년창상환자수량(t=7.31,P＜0.01)급기재총체창상환자중소점비례(t=6.29,P＜0.01)균축년상승,평균년령축년증가(t=3.11,P＜0.05),반발병소득사이삼기출질병권중지수(WIC)축년증대(t=6.45,P＜0.01),병사솔축년하강(t=-4.27,P＜0.01),이평균ISS화ISS≥16분소점당년적비례균무명현변화(P＞0.05).질도상시수위치상원인,차축년증가(t=2.83,P＜0.05).2010-2014년조평균ISS(t=2.13,P＜0.05)화ISS≥16분소점비례(x2=3.92,P＜0.05)균고우2007-2009년조,단기병사솔각명현저우2007-2009년조(X2=4.33,P＜0.05).여비사망조비교,사망조환자년령경대、손상엄중정도경중、반수질병정황야경엄중,교통상발생솔경고(P균＜0.05). 결론 수착창상구치기술적개진화구치책략적완선,노년창상환자병사솔정하강추세.노년창상환자적반발병화치상원인제시,응중점가강대노년환자창상적예방.
Objective To analyze the epidemiological characteristics of elderly trauma patients in a single center.Methods A total of 1,646 elderly inpatients (age ≥ 65 years) admitted from January 2007 to December 2014 were chosen.There were 649 men and 997 women,aged 65-110 years (mean,76.7 years).Epidemiological changes were studied including gender,age,mechanisms of injury,sites of injury,injury severity score (ISS),mortality,causes of death,pre-existing medical conditions,hospital length of stay,and medical expense.According to the application of damage control technology and the establishment of emergency green channel,the patients were divided into 2007-2009 year group and 2010-2014 year group for analyzing reasons of the changes,while the different characteristics between death and non-death patients were analyzed.Results Elderly trauma patients presented annual increases in quantity (t =7.31,P ＜ 0.01) and proportion from the trauma population (t =6.29,P ＜ 0.01).There was an annual increasing in patients＇ mean age (t =3.11,P ＜ 0.05) and Charlson's weighted index of comorbidities (WIC) for the pre-existing medical conditions (t =6.45,P ＜0.01),while decreased mortality (t =-4.27,P ＜ 0.01) and no obvious variations in mean ISS and proportion of ISS ≥ 16 (P ＞ 0.05).Fall injury was the leading cause of injury and increased showed annually (t =2.83,P ＜ 0.05).Mean ISS (t =2.13,P ＜ 0.05) and proportion of ISS ≥ 16 (x2 =3.92,P＜0.05) were higher in 2007-2009 year group than in 2010-2014 year group.Besides the mortality lowered in 2007-2009 year group compared to that in 2010-2014 year group (x2 =4.33,P ＜ 0.05).In contrast to survivors,nonsurvivors were older,had more severe injury,sustained more severe associated conditions and experienced high incidence of traffic crashes (P ＜ 0.05).Conclusions With the improved trauma care levels and protocols,mortality rate for the elderly trauma patients has been lowered.In consideration of the associated conditions and injury causes,the focus should be on strengthening trauma prevention in the elderly.