肾损伤程度等因素对肾损伤治疗方式选择及预后的影响

Factors Influencing the Management and Prognosis of Renal Injury

目的了解肾损伤程度(Sargent分类法)、开放或闭合性`损伤、全身损伤严重程度评分(injuryseverityscore,ISS)、休克等相关因素对手术率及死亡的影响。方法采用设计好的调查表,收集我院1998年至2002年间221例外伤性肾损伤的住院病历资料,应用logistic回归分析肾损伤治疗方式选择和预后的影响因素。结果本组平均年龄31.6岁,男191例(86.4%),女30例(13.5%)。其中闭合性损伤175例(79.2%),开放性损伤46例(20.8%),合并伤101例(45.7%),死亡6例(2.7%)。多因素logistic回归分析的结果显示:是否手术主要与肾损伤程度、损伤原因和休克有关[OR=5.965,95%CI(2.767,12.859);OR=4.667,95%CI(1.725,12.628)和OR=2.547,95%CI(1.684,3.936)]。肾切除与否主要与肾损伤程度有关[OR=11.550,95%CI(4.253,31.366)]。死亡与全身损伤严重程度的ISS评分有关[OR=1.236,95%CI(1.082,1.411)]。结论肾损伤的手术率与肾损伤程度、损伤原因和休克有关,肾损伤程度决定是否术中切肾,死亡则主要与合并伤导致的ISS评分的增高有关。

Objective To evaluate factors such as renal injury grade （ Sargent Method）, blunt or penetrative renal injury, injury severity score（ISS） , and shock influencing the need for operation or nephrectomy, and predictive of mortality in renal injury. Methods A well^tesigned questionnaire was used to collect medical records retrospectively. Two hundred and twenty-one cases of renal injury in West China Hospital from 1998 to 2002 were included, logistic regression analysis was used for multi-factors analysis. Results The average age of the 221 cases was 31.6, with 191 males （86.4%） and 30 females （ 13.6% ）, 175 blunt injuries （79.2%） and 46 penetrative injuries （20.8%） , and 101 concomitant injuries （45.7%）. Six cases died of renal injury （2.7%）. The results of logistic regression showed that the need of operation was related to injury grade, Type of renal injury, and shock significantly. ORs （ odd ratios） were 5. 965 with 95% CI 2. 767 to 12. 859, 4. 667 with 95% CI 1. 725 to 12. 628, and 2. 547 with 95% CI 1. 684 to 3. 936 respectively. The need of nephrectomy was significantly related to injury grade with OR 11. 550 and 95% CI 4. 253 to 31. 366. The death was significantly related to ISS with OR 1. 263 and 95% CI 1. 082 to 1. 411. Conclusions The results of our data suggest the need of operation depends on injury grade, blunt or penetrative renal injury, and shock. The need of nephrectomy depends on injury grade. The death is related to ISS.