腹部外伤患者院前评估指标与预后间的关系

The relationship between pre-hospital assessment and prognosis on patients with abdominal trauma

目的通过分析腹部外伤患者入院前血压、血氧、外伤至手术间隔时间、术前休克时间4项指标与死亡率之间的关系,明确院前急救重点和应采取的有效措施,同时对预后作出初步判断。方法回顾性分析本院2011年1月至2014年4月收治的140例腹部外伤患者病历资料,统计入院前血压、血氧、外伤至手术间隔时间、术前休克时间4项指标,采用常规和趋势χ2检验,分析其与死亡率的关系。结果 1低血压组患者死亡率为83.3%,正常组为41.6%,高血压组为48.6%,三组比较差异无显著性(P>0.05);2低血氧组患者死亡率为76.9%,正常组为44.1%,两组比较差异显著(P<0.05);3外伤至手术间隔时间>12小时组患者死亡率为70.6%,≤12小时组为27.6%,两组比较差异显著(P<0.05);4术前休克时间>6小时组患者死亡率为85.4%,≤6小时组为52.5%,两组比较差异显著(P<0.05)。Logistic回归分析显示,上述4项指标均是腹部外伤患者预后的显著影响因素。结论腹部外伤患者外伤至手术间隔时间超过12小时、术前休克时间超过6小时、低血压和低血氧提示患者预后不良。

Objective By analyzing the relationship between blood pressure, blood oxygen, interval time from trauma to surgery, preoperative shock time and mortality of patients with abdominal trauma, to make clear focus on pre-hospital emergency care and effective measures should be taken, also may make the preliminary judgment on the prognosis. Method A retrospective analysis of medical records of 140 patients with abdominal trauma in our hospital from January 2011 to April 2014 were carried out, counted blood pressure, blood oxygen, interval time from trauma to surgery, preoperative shock time, using conventional and trend χ2 test to analyze its relationship with mortality. Result 1 The mortality of patients in hypotension group was 83.3%, normal group was 41.6%, and hypertension group was 48.6%, the difference between the three groups was not significant（P〈0.05）. 2 The mortality of patients in hypoxemia group was 76.9%, normal group was 44.1%, the difference between the two groups was significant（P〈0.05）. 3 The mortality of patients in interval time from trauma to surgery 12 hours group was 70.6%, ≤ 12 hours group was 27.6%, the difference between the two groups was significant（P〈0.05）. 4 The mortality of patients in preoperative shock time 6 hours group was 85.4%, ≤ 6 hours group was 52.5%, the difference between the two groups was significant（P〈0.05）. Logistic regression analysis showed that the 4 indicators were significant factors affecting the prognosis of patients with abdominal trauma. Conclusion Interval time from trauma to surgery 12 hours, preoperative shock time 6 hours, hypotension and hypoxemia are the indicators of poor prognosis in patients with abdominal trauma.