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影响严重创伤合并急性肺损伤的患者病死率危险因素分析 被引量：1

Analysis of clinical risk factors associated with mortality of severe trauma patients with acute lung injury
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摘要 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，APACHE）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。 Objective To identify the potential risk factors affecting mortality rate of ALI in severe trauma population. Method it was a retrospective cohort study treating trauma as a single cause for emergency department （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. Results There were 343 severe trauma patients with post-traumatic ALI admitted to ED and EICU the Second Affiliated Hospital Medical College, Zbejiang University, during the study period. The five risk factors that affected the mortality with tmadjusted 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 subpopulations at different degrees. Conclusions Factors of APACHE Ⅱ score and aspiration of gastric contents that can predict the mortality of ALI 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 further aggravation.
作者 盛蕾 伍峻松 马岳峰 张茂 徐少文 江观玉
机构地区 浙江医学高等专科学校护理系 浙江大学医学院附属第二医院急诊科
出处 《中华急诊医学杂志》 CAS CSCD 北大核心 2009年第2期185-189,共5页 Chinese Journal of Emergency Medicine
关键词 创伤 急性肺损伤 病死率 危险因素 APACHEⅡ评分 Trauma Acute lung injury Mortality Risk factors APACHE Ⅱ score
分类号 R64 [医药卫生—外科学] R563.8 [医药卫生—呼吸系统]
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参考文献19

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二级参考文献9

共引文献11

同被引文献22

  • 1伍峻松,易建华,盛蕾,施小燕,杨俭新,黄宗坚,干建新.影响严重多发伤并发急性肺损伤及急性呼吸窘迫综合征患者生存率危险因素分析[J].中华医学杂志,2006,86(11):753-758. 被引量：13
  • 2Bernard GR,Artigas A,Brigham KL,et al.Report of the American-European consensus conference on acute respiratory distress syndrome:definition,mechanisms,relevant outcomes,and clinical trial coordination.Am J Respir Crit Care Med,1994,151:818-824.
  • 3Cooper AB,Ferguson ND,Hanly PJ,et al.Long-term follow-up of survivors of acute lung injury:lack of effect of a ventilation strategy to prevent barotraumas.Crit Care Med,1999,27:2616-2621.
  • 4Davidson TA,Caldwell ES,Curtis JR,et al Reduced quality of life in survivors of acute respiratory distress syndrome compared with critically ill control patients.JAMA,1999,281:354-360.
  • 5Estenssoro E,Dubin A,Laffaire E,et al.Incidence,clinical course,and outcome in 217 patients with acute respiratory distress syndrome.Crit Care Mad,2002,30:2450-2456.
  • 6Valta P,Unsaro A,Nunes S,et al.Acute respiratory distress syndrome:frequency,clinical course,and costs of care.Crit Care Med,1999,27:2367-2374.
  • 7Hoyt DB,Simons PK,Winchell RJ,et al.A risk analysis of pulmonary complications following major trauma.J Trauma,1993,35:524-531.
  • 8Hudson LD,Milberg JA,Anardi D,et al.Clinical risk for development of the acute respiratory distress syndrome.Am J Respir Crit Care Mad,1995,151:293-301.
  • 9Moore FA,Moore EE,Read RA.Post-injury multiple organ failure:role of extrathoracic injury and sepsis in adult respiratory distress syndrome.New Horiz,1993,1:538-549.
  • 10Knaus WA,Draper EA,Wagner DP,et al.APACHE:a severity of disease classification system.Crit Care Med,1985,13:818-829.

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中华急诊医学杂志
2009年 第2期

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