老年创伤患者临床特征和死亡危险因素分析

Clinical features of senile severe traumatic patients and risk factors for mortality

目的：总结老年重症创伤的临床特征，分析死亡危险因素。方法回顾性地分析2010年1月至2014年10月张家港市第一人民医院重症监护室（ICU）收治的130例老年创伤患者和120例青中年创伤患者的致伤原因、伤情、救治及转归。结果老年创伤组急性生理与慢性健康评分（APACHE Ⅱ）为（19.71±12.48）分，合并基础疾病率39.2%，住ICU的时间为（6.17±5.97）d，机械通气率56.2%，多器官功能不全综合征（MODS）发生率36.9%，肺部感染发生率22.3%，病死率34.6%，均高于青中年创伤组（P＜0.05）。结论老年创伤患者病死率高于中青年患者，APACHE Ⅱ评分、较多的基础疾病和MODS的发生是其独立危险因素。

Objective To investigate the clinical features of severe trauma in the elderly and analyze the risk factors for death. Methods Clinical data of 130 elderly traumatic patients and 120 young and middle-aged traumatic patients admitted in Intensive Care Unit （ICU） of our hospital from January 2010 to October 2014 were collected and retrospectively analyzed. The cause, traumatic condition, treatment and prognosis were analyzed and compared between the 2 groups. Results In the elderly trauma group, the scores of acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） was 19.71±12.48, 39.2% of them had comobidities, their mean length of ICU stay was （6.17±5.97）d, the rate of mechanical ventilation was 56.2%, the incidence of multiple organ dysfunction syndrome （MODS） and pneumonia were 36.9% and 22.3%, respectively, and the mortality was 34.6%. All these values were significantly higher than those in the young and middle-aged group （P〈0.05）. Conclusion The mortality is higher in elderly than in young and middle-aged traumatic patients. The APACHE Ⅱ score, more comobidities and occurrence of MODS are the independent risk factors for death.