创伤后MODS危险因素分析

Analysis of risk factors for multiple organ dysfunction syndrome after severe trauma

目的探讨重度创伤后MODS演变的危险因素，以期进一步提高救治水平。方法回顾性分析1992年1月-2006年6月2152例中严重创伤患者的临床资料，分析各种因素与并发MODS的关系。结果2152例中合并MODS284例。经Logistic回归分析，慢性病史（β=1．057，OR=2．881）、伤后休克时间（β=1．287，OR=3．499）、伤后并发感染（β=1．581，OR=3．471）、AIS—ISS评分（β=2．105，OR=4．269）、乳酸（β=1．187，OR=3．279）、碱缺失（β=1．626，OR=4．169）和血糖（β=1．087，OR=2．792）是MODS的主要危险因素。结论MODS的发生与多种因素有关，在处理原发病的同时，重视慢性病史，缩短休克时间，加强抗感染，控制应激反应强度，控制血糖，监测乳酸和碱缺失，保护各器官功能是降低MODS发生的关键。

Objective To discuss the risk factors contributing to development of multiple organ dysfunction syndrome （MODS） after severe trauma in order to improve level of treatment. Methods The clinical data of 2,152 cases of trauma from January to June 2006 were retrospectively analyzed to clarify the relationship between various factors and MODS. Results Of all, 284 cases deteriorated to MODS. Logistic regression analysis showed that history of chronic diseases （ β = 1. 057 ,OR =2. 881 ）, posttraumatic duration of shock （ β = 1. 287, OR = 3. 499 ）, posttraumatic infection （ β = 1.581, OR = 3.471 ）, abbreviated injury scale - injury severity score （ AIS - ISS） （ β = 2.105, OR = 4.269 ）, lactic acid （ β = 1.187, OR = 3. 279 ） , base deficit （ β = 1. 626, OR = 4.169 ） and glycemia （ β = 1. 087, OR = 2.792 ） were main risk factors leading to MODS. Conclusions Development of MODS is correlated with many factors. Addition to active treatment of the primary injury, regarding history of chronic diseases, shortening posttraumatic shock duration, strengthening anti-infection therapy, controlling intensity of stress response, regulating level of glycemia, measuring lactic acid and base deficit and prophylactically protecting the function of each organ are of importance to reduce the morbidity of MODS.