严重多发伤的ICU治疗及预后相关因素分析

Intensive care and management for severe polytrauma

目的探讨严重多发伤病情评估与预后相关性及ICU救治的策略特点。方法回顾性分析我院中心ICU 2009年1月～2010年5月收治的严重多发伤病人50例临床资料,计算入院24小时内ISS评分和急性生理慢性健康评分(APACHEⅡ),对死亡组、存活组的ISS值及APACHEⅡ分值进行比较。结果死亡6例,死亡率12%;早期死亡2例,主要原因为失血性休克及急性呼吸窘迫综合征(ARDS),后期死亡4例,主要死因为多器官功能损害(MODS)。死亡组与存活组ISS值差别无统计学意义(P>0.05),而A-PACHEⅡ分值前者明显高于后者(P<0.01)。结论在极危重多发伤(ISS≥25)为主的人群中,APACHEⅡ分值与病人最终的预后相关,APACHEⅡ评分在其严重程度及预后相关性上有较高价值;ICU的救治和病情预后相关策略中,早期限制性液体复苏原则的把握、血糖管理、感染的防控是值得关注的重要问题。

Objective To evaluate the prognosis-related factors and significance of treatment strategies of multiple trauma in ICU.Methods The clinical data of 50 patients admitted to our central ICU from Jan.2009 to May.2010 were studied retrospectively.The ISS score and the APACHEⅡ score were calculated within 24 hours of admission.The ISS score and APACHEⅡ score of death group and survival group were compared.Results Totally 44 patients survived and 6 patients died of hemorrhagic shock,acute respiratory distress syndrome（ARDS） and multiple organ dysfunction syndrome（MODS）.There was no significant difference of ISS score between death group and survival group（P〉0.05）,but the APACHEⅡ score in death group was higher than that in survival group（P〈0.01）.Conclusion APACHEⅡ is more relevant to the prognosis of the severe multiple trauma patients（ISS≥25）.It has higher specificity value in disease severity and prognosis.About the treatment strategies in ICU,early limited fluid resuscitation,blood glucose management,infection prevention and treatment are important issues of concern.