严重腹部创伤患者死亡危险因素分析

Analysis of Risk Factors of Mortality in Patients with Severe Abdominal Trauma

目的筛选分析严重腹部创伤患者死亡危险因素。方法收集2000年1月—2008年12月第三军医大学西南医院严重腹部创伤并行剖腹手术救治的192例的临床资料,回顾分析所有患者入院时生命体征、创伤评估、主要实验室检查结果、临床救治情况。根据救治的最终结局,将患者分为存活组和死亡组,比较分析两组不同指标间的差异。结果通过手术、液体复苏和对症支持治疗,192例成功救治175例,救治成功率91.15%;死亡17例,病死率8.85%,死亡主要原因为休克、重型颅脑损伤和脓毒症。脉搏、收缩压、伤情评估指标、白细胞、血红蛋白、红细胞压积、血小板、凝血酶原时间、血糖、伤后来院时间、手术次数、输血量及住院时间比较差异均有统计学意义(P<0.05或P<0.01)。结论严重腹部创伤患者死亡除与伤情严重程度直接相关外,还与其生理状态恶化及继发性病理生理学改变密切相关,及时纠正并阻断病情恶化对挽救患者生命具有重要的意义。

Objective To screen and analyze risk factors in patients with severe abdominal trauma so as to reduce mortality rate. Methods A retrospective review of our trauma database from January 2000 to December 2008 was conducted. Demographics, injury severity evaluation and clinical data, such as vital signs, laboratory examination results, mortality and the main causes were collected and analyzed. A comparison was made between groups of the survived and the dead. Results 175 patients （91. 15% ） survived by means of operation, fluid resuscitation and supportive treatment, only 17 patients （8.85%） died. The main causes of death were shock, severe head injury and sepsis. There were significant difference be- tween the patients of the two groups （the survived and the dead） in heart rates, systolic pressure, WBC, Hb, HCT, PLT, LOS, surgical times and blood transfusion （P 〈 0.05 or P 〈 0.01 ）. Conclusion The death of severe traumatic patients is not only related to injury severity, but also related to the deterioration of physiological status and secondary pathophysiological changes. It is of critical value to quickly block and correct the abnormal deterioration for these patients. It is also of great sig- nificance to correct and stop deterioration of the condition in order to save the patient＇s life.