创伤后急性呼吸功能不全的危险因素分析

Risk factors for acute respiratory dysfunction in trauma patients

目的探讨创伤后急性呼吸功能不全(acute respiratory dysfunction,ARD)的相关危险因素。方法回顾性分析207例创伤患者的临床资料,其中ARD患者53例(观察组),非ARD患者154例(对照组),对与其可能相关的年龄、休克时间、创伤指数(trauma index,TI)评分、急性生理学和慢性健康状况Ⅲ(Acute Physiology and Chronic HealthEvaluationⅢ,APACHEⅢ)评分、是否合并基础疾病等12项因素进行统计分析。结果单因素分析结果显示,2组在年龄≥65岁、休克持续时间≥3h、TI评分≥17分、24h输血量>3u、APACHEⅢ评分≥35分、肺部感染、合并糖尿病比例及血糖值上差异有统计学意义(P<0.05);多因素分析结果显示,年龄≥65岁、休克持续时间≥3h、TI评分≥17分、24h输血量>3u、APACHEⅢ评分≥35分是创伤后ARD的危险因素(P<0.05),其中APACHEⅢ评分≥35分是其高危因素(P<0.01)。结论对有以上危险因素的创伤患者,应加强肺功能监测和保护,及时采取有效抗休克、抗感染等治疗措施,是降低ARD发生的关键。

Abstract： Objective To study the risk factors for acute respiratory dysfunction （ARD） in trauma patients. Methods The clinical data of 207 trauma patients were retrospectively analyzed including 53 ARD patients （observation group） and 154 non-ARD patients （control group）. All these patients were analyzed statistically the 12 related factors including age, shock duration, trauma index score, Acute Physiology and Chronic Health Evaluation （APACHE） Ⅲ score, and whether complicated with or without basic diseases. Results Univariate analysis showed that there were significant differences in age （≥65 years） , shock duration （≥3 hours） , trauma index score （≥17）, 24-hour blood transfusion volume （〉3 u）, APACHE Ⅲ score （≥35）, lung infections, incidence of complication of diabetes mellitus, and plasma glucose value between two groups （P〈0.05）. Multivariable analysis showed that age （≥65 years）, shock duration （≥3 hours）, trauma index score （≥17）, 24-hour blood transfusion volume （〉 3 u） and APACHE Ⅲscore （≥35） were the risk factors for ARD after trauma （P〈0.05） , and APACHE Ⅲ score （≥35） was the high risk factor for ARD （P〈0.01）. Conclusion Trauma patients with the above risk factors should receive lung function monitoring and protection. Taking timely and effective anti shock and anti-infection treatment is the key to reducing the occurrence of ARD in trauma patients.