骨盆骨折伴直肠肛管损伤患者死亡风险调查及急诊处理研究

Death risk and emergency treatment of patients with pelvic fracture complicated with anorectal injury

目的研究骨盆骨折伴直肠肛门损伤患者的死亡危险因素,并提出急诊处理措施建议。方法回顾性分析我院35例盆骨骨折伴直肠肛管损伤患者病历资料,采用Fisher精确概率法分析性别年龄等基本人口学资料及骨折类型、ISS评分、感染、休克等病历资料与患者死亡率的相关性,对分析具有统计学意义的风险因子进一步行Logistic多因素回归分析,找出死亡独立危险因素,并提出急诊处理措施建议,随访观察治疗效果。结果 35例患者存活30例,死亡5例,死亡率14.29%。经单因素和Logistic多因素回归分析,创伤严重程度(ISS)评分(OR=1.934,P=0.014)与是否休克(OR=1.758,P=0.021)是影响患者死亡率的独立危险因素。经急救复苏和直肠肛管及合并伤处理等急诊处理方法和骨折复位内固定术后,随访1年,治疗优良率为86.67%。结论 ISS评分与是否休克是影响骨盆骨折伴直肠肛管损伤患者死亡率的独立危险因素,及时进行复苏抢救,处理直肠肛管及合并伤,有助于维持生命体征稳定,控制出血和感染,有效纠正创伤,防治失血性休克,降低死亡率,改善预后。

Objective To study the risk factors of death in patients with pelvic fracture complicated withanorectal injury and put forward emergency treatment measures.Methods The medical records of 35 patients with pelvic fracture complicated withanorectal injury were analyzed retrospectively. The correlation between basic demographic data, such as gender and age, fracture type, ISS score, infection, shock and other medical records and mortality was analyzed by Fisher＇s exact test. The risk factors with statistical significance were further analyzed by Logistic multivariate regression analysis. The independent risk factors of death were found out and the emergency treatment measures were put forward.The treatment effect was observed. Results In 35 cases, 30 cases survived, 5 cases died, and the mortality rate was 14.29%. Univariate and multivariate regression analysis showed that injury severity score（ISS）（OR=1.934, P=0.014） and with or without shock（OR=1.758, P=0.021） were independent risk factors for mortality.After resuscitation, emergency treatment for anorectal and associated injuries, fracture reduction and internal fixation, all the patients were followed up for 1 year, and the excellent and good rate of treatment was 86.67%.Conclusion ISS score and with or without shock are the independent risk factors for mortality in patients with pelvic fracture complicated with anorectal injury. Timely resuscitation, treatment of anorectal and associated injuries helps to maintain stable vital signs, control hemorrhage and infection, effectively correct the trauma, control hemorrhagic shock, reduce the mortality and improve the prognosis.