四肢战创伤并发急性肾衰竭危险因素的logistic回归分析

Logistic regression analysis of the risk factors of acute renal failure complicating limb war injuries

目的探讨四肢战创伤并发急性肾衰竭(ARF)的危险因素。方法回顾性分析1968-2002年收治的352例四肢战创伤患者,根据是否发生ARF将患者分为ARF组(9例)和非ARF组(343例)并进行病例对照研究,选择可能影响患者死亡的10个因素(致伤物、伤后是否休克、伤后入院时间、受伤部位、有无合并伤、手术次数、有否异物存留、骨折性质、是否截肢、止血带时间)进行logistic回归分析,筛查导致ARF的危险因素。结果 352例患者中共死亡15例,死亡原因包括ARF 7例(46.7%)、肺栓塞3例(20.0%)、气性坏疽3例(20.0%)、多器官功能衰竭2例(13.3%)。单因素分析显示,伤后是否休克、伤后入院时间、是否截肢、止血带时间为四肢战创伤后ARF的危险因素(P<0.05);多因素logistic回归分析显示,ARF发生的主要危险因素为截肢(P<0.05)。结论四肢战创伤的主要死亡原因为ARF。对肢体严重毁损、缺血坏死的患者,及时正确的处理及选择合适的截肢时机有利于降低ARF的发生率和死亡率。

Objective To explore the risk factors of complication of acute renal failure（ARF） in war injuries of limbs.Methods The clinical data of 352 patients with limb injuries admitted to 303 Hospital of PLA from 1968 to 2002 were retrospectively analyzed.The patients were divided into ARF group（n=9） and non-ARF group（n=343） according to the occurrence of ARF,and the case-control study was carried out.Ten factors which might lead to death were analyzed by logistic regression to screen the risk factors for ARF,including causes of trauma,shock after injury,time of admission to hospital after injury,injured sites,combined trauma,number of surgical procedures,presence of foreign matters,features of fractures,amputation,and tourniquet time.Results Fifteen of the 352 patients died（4.3%）,among them 7 patients（46.7%） died of ARF,3（20.0%） of pulmonary embolism,3（20.0%） of gas gangrene,and 2（13.3%） of multiple organ failure.Univariate analysis revealed that the shock,time before admitted to hospital,amputation and tourniquet time were the risk factors for ARF in the wounded with limb injuries,while the logistic regression analysis showed only amputation was the risk factor for ARF（P0.05）.Conclusion ARF is the primary cause-of-death in the wounded with limb injury.Prompt and accurate treatment and optimal time for amputation may be beneficial to decreasing the incidence and mortality of ARF in the wounded with severe limb injury and ischemic necrosis.