摘要
目的评价老年人严重创伤致伤原因的构成及预后。方法回顾性分析严重创伤患者1090例的临床资料，其中老年组60～91岁168例，中年组（36～59岁）517例、青年组（18～35岁）405例。用简明损伤定级（AIS2005）和损伤严重程度评分（ISS）标准进行评估，所有患者ISS≥16分。比较三组的损伤严重度、损伤部位数、致伤原因、致伤部位、急诊手术、伤前的原有疾病、伤后继发感染、脏器功能不全、入住重症监护病房（ICU）的例数、ICU的住院时间及最终预后。结果老年组主要致伤原因是意外伤害（64例，占38．1％），其次是交通事故（63例，占37．5％），中年和青年组主要致伤原因是交通事故（分别为246例和153例，占47．6％和37．8％），其次是高处坠落（分别为128例和102例，占24．8％和25．2％）；老年、中年和青年组主要损伤部位均是头胸部（分别为155例、411例和321例，占92．3％、79．5％和79．3％）；三组的损伤部位数F=8．299，P〈0．01、急诊手术X^2=14．88，P=0．001、伤前原有疾病X^2=254．6，P〈0．01、伤后继发感染X^2=10．54，P=0．005、入住ICU的例数X^2=15．62，P〈0．01和ICU住院时间F=5．760，P=0．005等差异均有统计学意义，损伤程度的差异虽无统计学意义（F=2．950，P=0．053），但老年组分别与中年、青年组比较，差异均有统计学意义（t值分别为2．325、2．128，P值分别为0．034、0．021）；三组的脏器功能不全的发生率差异无统计学意义（X^2=1.142，P=0．565）；三组的治愈率及未愈而自动出院率的差异均有统计学意义（分别X^2=13．77，P=0．001和X^2=6．025，P=0．049），病死率差异无统计学意义；三组的主要死亡原因是严重的头部损伤。结论对于老年严重创伤患者应减少意外伤害和交通事故，积极采取有效的救治措施是提高治愈率、降低未愈及病死率的关键。
Objective To evaluate the causes and prognosis of severe trauma in the elderly. Methods The 168 patients in elderly group （aged 60 to 91 years）, 517 in middle-aged group （aged 36 to 59 years） and 405 in young group （aged 18 to 35 years） were evaluated using an abbreviated injury scale （AIS2005） and injury severity score （ISS）. All patients with ISS ≥ 16 were selected during a seven-year period. The injury severity, injury site number, cause of injury, injury site, emergency operation, diseases before injury, secondary infection after injury, development of multiple organ dysfunction, number of patients with Intensive Care Unit （ICU） stay, length of stay in ICU and prognosis were compared among three groups. Results The main cause of injury was accident （64 patients, 38.1%）, followed by traffic accident （63 patients, 37.5%） in elderly group. The traffic accident was major cause of injury in middle-aged and young group （246 patients, 47.6%; 153 patients, 37.8%, respectively）, followed by fall from high places （128 patients, 24.8%; 102 patients, 25.2%, respectively）. The main injury sites were head and chest in elderly, middle-aged and young group （155 patients, 92.3%; 411 patients, 79.5%; 321 patients, 79.3%, respectively）. There were significant differences among three groups in injury site number, emergency operation, pre-injury diseases, secondary infection after injury, number of patients with ICU stay and length of stay in ICU （F=8. 299, P〈0. 01; X^2 =14.88, P=0. 001;X^2 =254.6, P〈0. 01; X^2 =10.54, P=0.005; X^2=15.62, P〈0.01; F=5.760, P=0.005, respectively ）. In spite of injury severity （F= 2. 950, P= 0. 053）, there were significant differences between elderly group and middle-aged or young group （t=2.325, P=0.021; t=2.128, P=0.034, respectively）. The incidence of multiple organ dysfunction had no significant difference among the three groups （X^2= 1. 142, P= 0. 565）. The cure rate and unhealed automatically discharged patients had significant differences （X^2= 13.77, P= 0. 001; X^2=6.025, P=0.049, respectively）. The mortalities were similar （X^2=1.397, P=0.497）. The leading cause of death among three groups was a serious head injury. Conclusions For elderly patients, it is important to reduce accidental injuries and traffic accidents, to improve the cure rate, and to reduce the unhealed and mortality rate.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2011年第2期144-147,共4页
Chinese Journal of Geriatrics
关键词
创伤和损伤
预后
Wounds and injuries
Prognosis
