严重创伤患者放射学检查的构成及影响因素

Composition and associated factors of radiological examination in major trauma patients

目的了解严重创伤患者救治中放射学检查的构成及影响因素，为优化放射学检查策略提供依据。方法为前瞻性观察研究，收集浙江大学医学院附属第二医院（三级甲等综合性医院）急诊ICU于2010年4-7月收治的60例严重创伤患者的资料，描述放射学检查的类型、数量、部位构成及同一部位重复检查情况；比较不同治疗阶段放射学检查部位构成和数量的差异；分析放射学检查的数量与患者年龄、受伤部位数目、损伤严重度评分（ISS）、格拉斯哥昏迷评分（GCS）、ICU和总住院时间等因素的相关性。结果（1）60例患者的放射学检查主要为x线片和CT，人均摄片量的中位数为6（四分位数3～11），人均CT检查量中位数为10（四分位数8．0～13．8）。（2）x线片的应用在急诊室、ICU、普通病房3个阶段相对均衡（）（X＾2=4．043，P=0．132），CT则主要在急诊室和ICU阶段完成（X^2=20．274，P〈0．1）。（3）不同治疗阶段X线片和cT检查的部位构成不同（X^2=114．609，75．932，均P〈0．01）。（4）CT检查数量与受伤部位数、ISS值、ICU和总住院天数存在相关性（r分别为0．273，0．369，0．523，0．417，P〈0．05）。结论严重创伤患者放射学检查的数量比较大，主要是x线片和CT检查，并以CT的应用更多；CT检查数量与创伤的严重程度及ICU住院天数正相关，有必要进一步研究以优化放射学检查的策略。

Objective To explore the determinant factors influencing the constituent parts of radiolog- ical examination in severe trauma patients so as to provide scientific basis for optimized strategy of radiological examination. Methods A prospective study was carried out from April to July 2010 in a tertiary hospital. Clinical data of 60 severe trauma patients admitted to emergency department and ICU were recorded. The type, number and site of trauma under radiologieal examination were described and compared among different stages of treatment. The correlation between number of radiological examinations and age, number of injured site, injury severity score （ISS） , Glasgow Coma Scale （GCS） , ICU stay and overall length of hospital stay were analyzed. Results （ 1 ） The majority of radiological examinations in 60 patients were radiography and CT, with a corresponding median number of 6.0 （ 3.0 - 11.0, IQR） and 10.0 （ 8.0 - 13.8, Qr） times per patient. （2） The numbers of radiography examinations requested in emergency room, emergency ICU and general ward were quite approximately equal （X^2 = 4. 043, P = 0.132 ） , while CT examinations were mainly requested in emergency room and emergency ICU （X^2 =20. 274,P 〈 0. 001 ）. （3） The numbers of radiological examinations requested for different sites of injury were quite significantly different between radiography and CT during different stages of treatment （ X^2 = 114. 609, 75. 932, P 〈0.01 ）. （4） The number of CT scan requested was positively correlated with number of injured site, ISS, ICU and overall length of hos- pital stay （r=0.273,0.369,0.523,0.417,all P 〈0.05）. Conclusions The sum of radiologieal examinations in severe trauma patients was great mainly in radiography and CT, and CT was more predominantly requested. The number of CT scans examinations was positively correlated with severity of injury and length of ICUstay. Further study is warranted to optimize radiological examination in severe trauma patients.