多发伤患者早期应激并发症危险因素分析

Analysis of risk factors for early stress complications in patients with multiple trauma

目的:探讨多发伤患者早期应激并发症的危险因素。方法:收集64例多发伤患者的病例资料,对相关的因素进行单因素及多因素的Logistic回归分析。结果:48例患者出现应激性溃疡、急性呼吸窘迫综合征等应激并发症,单因素回归分析表明,急性生理和慢性健康评分(APACHⅡ)、血皮质醇(COR)、促肾上腺皮质激素(ACTH)、三碘甲状腺原氨酸(TT3)、游离三碘甲状腺原氨酸(FT3)、甲状腺素(TT4)、白介素-1(IL-1)、白介素-6(IL-6)、白介素-8(IL-8)、白介素-10(IL-10)、肿瘤坏死因子(TNF-α)差异有统计学意义(P<0.05);多因素Logistic分析表明,APACHⅡ评分、TT4、皮质醇、IL-6、IL10、TNF-α为早期应激并发症的独立危险因素。结论:多发伤患者APACHⅡ评分以及TT4、皮质醇、IL6、IL10、TNF-α等指标的变化与患者应激性消化道出血及呼吸窘迫综合征等应激并发症的出现呈密切相关。

Objective： To investigate the risk factors for early stress complications in patients with multiple trauma.Methods： Clinical data of 64 patients with multiple trauma were statistically analyzed by univariate and multivariate logistic regression. Results： 48 patients occurred stress complications such as stress ulcer and acute respiratory distress syndrome（ ARDS）. Univariate logistic regression revealed that there were statistic differences in APACHⅡ score,level of cortisol（ COR）,ACTH,TT3,FT3,TT4,IL-1,IL-6,IL-8,IL-10 and TNF-α（ P 0. 05）. By multivariate analysis in which APACH Ⅱ score,COR,TT4,IL-6,IL-10,TNF-α were the independent risk factors for early stress complications. Conclusion： Changes of APACH Ⅱ score,COR,TT4,IL-6,IL-10 and TNF-α were apparently correlated with stress complications occurred in patients with multiple trauma.