摘要
目的探讨多发性损伤患者临床预后转归的独立危险因素。方法回顾性队列研究分析南昌大学第一附属医院2013年1月—2017年6月收治的542名多发性损伤患者病例资料,根据入院后24 h内红细胞（red blood cell,RBC）输注量将患者分为输血组和未输血组,其中输血组患者164例,未输血组378例,比较分析2组患者临床基本资料和临床预后相关指标,并采用COX回归分析对患者院内死亡相关危险因素进行分析,以探讨多发性损伤患者临床预后转归的独立危险因素。结果 1）未输血组与输血组患者年龄（45. 72±13. 96 vs 45. 54±13. 14）、性别（292/86 vs 120/44）、多发性肋骨骨折发生率（31. 2%vs 39. 0%）、体温（36. 83±0. 55 vs 36. 73±0. 58）和致伤原因间差异均不具统计学意义（P〉0. 05）;创伤类型、颅骨骨折、骨盆骨折、创伤严重度评分（ISS）、格拉斯哥昏迷评分（GCS）、心率（HR）、收缩压（SBP）、舒张压（DBP）间差异均具有统计学意义（P〈0. 05）; 2） 2组患者血红蛋白（Hb）、血小板计数（Plt）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、国际标准化比值（INR）、急诊手术间差异均具有统计学意义（P〈0. 05）; 3）输血组患者院内死亡率、24 h死亡率、院内并发症发生率、机械通气时间、ICU住院时间、总住院时间均明显高于未输血组（P〈0. 05）,输血组患者均未发生输血不良反应; 4） COX单因素回归分析显示年龄、颅骨骨折、ISS、GCS、HR、SBP、Hb、Plt、PT、APTT、INR、RBC输注量、血浆输注量均为多发性损伤患者院内死亡的危险因素（P〈0. 05）,多因素分析结果仅显示年龄、颅骨骨折、HR和RBC输注量是多发性损伤患者院内死亡的独立危险因素（P〈0. 05）。结论年龄、颅骨骨折、HR和RBC输注量是多发性损伤患者院内死亡的独立危险因素。早期积极止血,合理输血可减少患者总用血量,降低并发症发生风险,改善多发性损伤患者临床预后。
Objective To explore the independent risk factors of clinical prognosis in patients with multiple trauma.Methods Retrospective analysis was performed on all the multiple trauma patients＇ clinical data in the First Affiliated Hospital of Nanchang University recorded from January 1,2013 to June 31,2017. A total of 542 cases were included. According to the amount of RBC transfused within 24 h after admission,the patients were divided into the transfusion group and the non-transfusion group. The transfusion group included 164 cases and the non-transfusion group included 378 cases. Clinical data and the treatment results of these cases were analyzed and compared. COX regression analysis was used to explore the risk factors of clinical prognostic of multiple trauma patients. Results 1） Age,sex,trauma causes,incidence of multiple rib fracture,and body temperature difference between the two groups were not statistically significant（ P〉0. 05）,but the difference between other clinical indicators were statistically significant（ P〈0. 05）. 2） There were significant differences in whole blood cell test,coagulation function and emergency surgery rate between the two groups（ P〈0. 05）. 3） In-hospital mortality,24 h mortality,in-hospital complication rate,mechanical ventilation time,ICU hospitalization time,and total hospitalization time were significantly higher in the transfusion group than in the non-transfusion group（ P〈0. 05）. No transfusion adverse reactions occurred in the transfusion group. 4） COX univariate regression analysis showed that age,skull fracture,injury severity score,glasgow coma scale,heart rate,systolic blood pressure,hemoglobin,platelet count,prothrombin time,activated partial thromboplastin time,international normalized ratio,RBC transfusion,and plasma transfusion were risk factors for in-hospital mortality in patients with multiple trauma（ P〈0. 05）,multivariate analysis showed only age,skull fracture,heart rate and RBC transfusion were independent risk factors.（ P〈0. 05）. Conclusion Age,skull fracture,heart rate and RBC transfusion were independent risk factors for inhospital mortality in patients with multiple trauma. Early active hemostasis and sensible blood transfusion strategies can reduce the total blood transfusion volume and the risk of complications,which serves to improve the clinical prognosis of patients with multiple trauma.
作者
赵菊红
刘威
乐爱平
ZHAO Juhong;LIU Wei;LE Aiping(Jiangxi medical service guidance center;Department of Blood Transfusion,The First Affiliated Hospital of Nanchang University,Nanchang 330006,China)
出处
《中国输血杂志》
CAS
2018年第7期703-707,共5页
Chinese Journal of Blood Transfusion
基金
江西省科技计划项目(20122BBG70114)
江西省科技重大项目(20144BBG70001)
