胸部为主多发伤并发感染的预测与辅助诊断

Prediction of chest trauma of multiple trauma complicated with infections and auxiliary diagnosis

目的探讨胸部创伤为主的多发伤并发感染的危险因素,探讨血浆中的白细胞介素-lβ(IL-lβ)、IL-4、IL-8、肿瘤坏死因子(TNFα)、γ干扰素(LFNγ)与感染的关系,以降低感染发生率。方法回顾性分析2011年2月-2013年2月265例以胸部创伤为主的多发伤患者的临床资料,按照是否并发感染分为感染组69例与非感染组196例;分析其并发感染的相关危险因素,并进行危险因素的单变量分析,探讨感染的高危因素。结果影响胸部创伤为主的多发伤并发感染的危险因素有多器官功能障碍综合征(MODS)评分高(>15分)、手术次数多(>2次)、使用呼吸机时间长(>7d)、并发症多(>2种)、存在肝肾功能不全和胃内容物误吸(P<0.05);感染患者的血浆IL-lβ、IL-4、IL-8、TNFα、TNFγ比非感染患者高,差异有统计学意义(P<0.05)。结论胸部创伤为主的多发伤并发感染的危险因素有MOFS评分高,有多种合并症、存在肝肾功能不全和胃内容物误吸等,血浆中的IL-lβ、IL-4、IL-8、TNFα、LFNγ值的升高可作为感染的参考指标。

OBJECTIVE To study the risk factors of chest trauma of multiple trauma complicated with infections and explore the correlation between the plasma IL-l beta,IL 4,IL-8,TNF alpha,γinterferon LFN gamma and the incidence of infections so as to reduce the incidence of infections.METHODS The clinical data of 265 cases of patients with chest trauma dominant by multiple trauma who were treated in the hospital from Feb 2011 to Feb 2013 were retrospectively analyzed,the patients were divided into the infection group with 69 cases and the non-infection group with 196cases according to the status of infections,then the univariate analysis of the risk factors was performed,and the high risk factors of the infections were explored.RESULTS The risk factors of the complicated infections in the chest trauma patients included the multiple organs dysfunction（MODS）score more than 15 points,operation frequency more than two times,use of ventilator more than 7days,more than two complications,presence of liver and kidney dysfunction,and aspiration of gastric contents（P0.05）.The level of the serum IL-l beta,IL-4,IL-8,TNF alpha,or TNF gamma of the patients with infections was significantly higher than that of the patients without infections,the difference was significant（P0.05）.CONCLUSIONThe risk factors of the complicated infections in the chest trauma patients include the high MODS score,multiple complications,presence of liver and kidney dysfunction,and aspiration of gastric contents.The elevated level of plasma ILl beta,IL-4,IL-8,TNF alpha,or LFNγgamma can be used as a reference indicator of the infections.