腹部损害控制性手术后早期死亡的危险因素分析

Risk factors for early death after abdominal damage control operation

目的探讨严重腹部创伤患者接受损害控制性术（DCO）后的早期死亡情况和危险因素。方法回归性分析2005年1月_2015年3月146例患者临床资料，早期死亡定义为首次术后72h内、确定性手术之前的死亡，并据此分为死亡组与生存组，记录两组性别、年龄、受伤时间、损伤分类、生命体征、是否需要心肺脑复苏、格拉斯哥昏迷评分（GCS）、损伤严重度评分（ISS）、血红蛋白、血小板、凝血酶原时间（门）、活化部分凝血活酶时间（APTT）、血液pH值、碱剩余、手术持续时间和术后急性生理和慢性健康评分Ⅱ（APACHEII）等。应用Logistic多元回归分析探讨术后早期死亡与其他变量之间的关系。结果生存组118例（80．8％），死亡组28例（19．2％）。生存组和死亡组：年龄（6．8％：21．4％，P〈0．05）、多发伤（62．7％：85．7％，P〈0．05）、体温[（36．1±0．4）oC：（35．2±0．8）℃，P〈0．05]、ISS（31．4％：64．3％，P〈0．05）、PT[（12．1±1．5）s：（13．9±1．2）s，P〈0．05]、血液pH值（7．25±0．04：7．08±0．11，P〈0．05）、碱剩余[（-8．9±2．8）mmol／L：（-10．6±3．3）mmol／L，P〈0．05）]、术后APACHEⅡ[（12．8±1．8）分：（17．5±2．0）分，P〈0．05]差异均有统计学意义。Logistic多元回归分析显示，年龄（OR：1．512，95％CI1．112—4．157，P〈0．05）、ISS（OR=1．313，95％CI1．134—5．442，P〈0．05）、APACHEⅡ（OR=1．361，95％CI1．182—5．222，P〈0．05）是影响早期死亡的独立危险因素。结论接受DCO的严重腹部创伤患者仍有较高的早期死亡率，并且与患者年龄、ISS和术后病情严重程度密切相关。

Objective To control operation （DCO） in patients report the early mortality and with severe abdominal trauma. associated risk factors after damage Methods A total of 146 patients hospitalized from January to March in 2015 were retrospectively analyzed. Early death was defined as death occurring within 72 h of first surgery and before the definitive surgery. Based on the death definition, the subjects were divided into death group and survival group. The two groups were compared for gender, age, injury time, injury classification, vital signs, need for cardiopulmonary resuscitation, Glasgow coma score （GCS）, injury severity score （ISS）, hemoglobin, platelets, prothrombin time （PT）, activated partial thromboplastin time （APTT）, blood pH, base excess, operative time, and postoperative acute physiology and chronic health evaluation score Ⅱ （APACHE Ⅱ ）. Logistic regression analysis was applied to examine the predicators of early postoperative mortality. Results There were 118 patients （80.8%） in survival group and 28 patients （ 19.2% ） in death group. Survival and death groups differed significantly with regard to the percent of elderly （ 6.8% vs. 21.4% ）, percent of patients with multiple injury （62.7% vs. 85.7% ）, body temperature [ （ 36.1± 0.4 ） vs. （ 35.2 ± 0.8 ） ℃ ], percent of patients with greater ISS （ 31.4% vs. 64.3 % ）, PT [ （ 12.1 ± 1.5 ） vs. （ 13.9 ± 1.2） s ],bloodpH （7.25±0.04 vs. 7.08±0.11）, base excess [（-8.9±2.8） vs. （-10.6±3.3）mmol/L], postoperative APACHE Ⅱ [ （ 12.8± 1.8 ） vs. （ 17.5± 2.0 ） points ] （ P 〈 0.05 ） . Logistic regression analysis identified the age （OR=1.512, 95% CI1.112-4.157,P〈0.05）, ISS （OR=1.313,95% CI 1. 134-5. 442, P 〈 0.05 ）, APACHE II （OR = 1. 361,95% CI 1.182-5. 222,P 〈 0.05 ） as the independent risk factors for early mortality. Conclusion The patients underwent DCO for severe abdominal trauma has a high early mortality, which is closely associated with the age, injury severity and postoperative medical status.