摘要
目的:探讨影响创伤性膈疝(traumatic diaphragmatic hernia,TDH)或膈肌损伤痛死率的危险因素。方法:收集51例TDH或膈肌损伤患者的临床资料,对死亡者(死亡组)与存活者(存活组)的临床资料进行对照研究,对12种相关因素进行统计学分析。结果:51例中,死亡9例,病死率为18%,死于早期(入院24h内)失血性休克4例,死于术后严重并发症5例,其中严重感染并ARDS2例、严重感染1例、ARDS1例、MODS1例。经统计学分析,2组间的年龄、损伤严重度记分分值、围手术期输血量、入院时有休克表现、术后并发症、入院时收缩压、脾脏损伤等级共7个因素的比较差异有统计学意义(均为P〈0.01),经多因素回归分析,围手术期输血量等于或大于1400mL、脾脏损伤等于或大于Ⅲ级等2个危险因素是TDH或膈肌损伤死亡的独立预测指标(比数比分别为41、74,P〈0.05—0.01)。结论:TDH或膈肌损伤患者术前有严重合并伤尤其是脾脏严重损伤,围手术期大量出血或术后出现严重并发症,提示预后较差。
Objective: To investigate the risk factors influencing mortality in traumatic diaphragmatic hernia (TDH) or diaphragmatic injury. Methods: Collecting the clinical data from the 51 patients admitted with TDH or diaphragmatic injury, and a contrast study was performed for exploring possible risk factors among 12 variables in the survival group and the death group by using statistic analysis. Results: Nine of fifty-one patients died and mortality was 18%, 4 patients died of hemorrhagic shock at early stage ( 〈24 h) and 5 patients died of postoperative sever complications, including sever infections and ARDS ( n = 2 ), sever infections ( n = 1 ), ARDS ( n = 1 ) and MODS(n = 1 ). Age, injury serverity score(ISS), volume of transfusion in perioperative period, on admission in shock, postoperative complications, systolic pressure and spleen injury scale etc 7 factors were different statistically between the two groups( both P 〈 0. 01 )by statistics analysis. Logistic regression analysis demonstrated that volume of transfusion during perioperative period ≥ 1 400 mL( OR = 41 ) and spleen injury scale ≥ Ⅲ ( OR=74) were both the independent predictors for mortality in TDH or diaphragmatic injury (P 〈 0. 05 - 0. 01 ). Conclusion: Sever associated injuries preoperatively especially sever splenic injury, bleeding too mach during perioperative period and sever complications postoperatively prompt bad prognosis in TDH or diaphragmatic injury patients.
出处
《新医学》
2009年第5期295-297,共3页
Journal of New Medicine
关键词
创伤性膈疝
膈肌损伤
手术
病死率
多因素回归分析
Traumatic diaphragmatic hernia Diaphragmatic injury Operation Mortality Logistic regression analysis