骨盆骨折患者临床预后及相关死亡原因分析

Prognosis Analysis of Pelvic Fracture And Risk Factors For Mortality

【目的】探讨骨盆骨折及其合并伤的·临床预后以及引起死亡的相关危险因素分析。【方法】收集2010年1月至2014年1月在本院就诊的360例骨盆骨折患者的临床资料，对患者的临床预后及其相关死亡危险因素进行回归分析。【结果】交通事故是引起骨盆骨折的最常见原因之一，其总的病死率为16．4％（59／360），包括早期（〈24h）因严重失血性休克致死24例，中晚期致死35例。经Fisher精确概率法分析显示：患者年龄、骨折分型、首个24h输血量、损伤严重度分数（ISS）、改进创伤评分（RTS）以及是否继发感染是骨盆骨折死亡危险因素。Logistic回归结果显示：首个24h输血量以及RTS（≤8）是早期死亡的危险因素；年龄以及RTS（≤8）是晚期死亡的危险因素。【结论】骨盆骨折病死率仍然很高，预后较差；早期积极有效的抗休克治疗、维持血流动力学稳定以及适时手术治疗能改善其临床预后。

[Objective] To explore the clinical prognosis and risk facyors for mortality for patients with pelvic fracture. [Methods] The clinical data of 360 patients with pelvic fracture from 2010 January to 2014 January were analyzed. Fishers exact test and Logistic regression analysis were performed for identifying the risk factors for clinical prognosis and mortality. [Results] Traffic accident was one of the most common causes of pelvic fracture. The overall mortality was up to 16.4%. And 24 cases died of serious hemorrhagic shock in early 24 h and another 35 died later. Fisher＇s exact test showed that age, fracture classification, blood transfusion for the first 24 h, injury severity score （ISS）, revised trauma score （RTS） and secondary infection were the risk factors for mortality. Logistic regression analysis indicated that blood transfusion for the first 24h and RTS （≤8） were two risk factors for early mortality while advanced age and RTS （≤8） were two risk factors for later mortality. [Conclusion] The mortality of pelvic fracture remains high and the prognosis is poor. Early treatment for shock, maintaining hemodynamics and timely operation can improve the prognosis greatly.