骨盆骨折对重度创伤患者院内结局的影响

Effect of pelvic fracture on hospital outcome in patients with severe trauma

目的评价骨盆骨折患者的临床特征及骨盆骨折对重度创伤患者院内结局的影响。方法选取在莒南县人民医院骨科ICU治疗的293例重度创伤存活患者。根据患者是否发生骨盆骨折，将患者分为骨盆骨折组（n=106）与非骨盆骨折组（n=187）。采用倾向性评分匹配法（PSM），根据年龄、性别和ISS评分对患者进行匹配，比较匹配后的两组患者临床特征和实验室指标。分析骨盆骨折患者的临床特征及骨盆骨折对重度创伤患者院内结局的影响。结果共匹配170例患者，每组各有85例。两组年龄、性别、ISS评分和致伤原因比较差异无统计学意义（均P〉0．05），但骨盆骨折组与非骨盆骨折组比较，ICU住院时间（t=10．800，P〈0．001）和总住院时间（t=11．242，P〈0．001）均显著提高；与非骨盆骨折组比较，骨盆骨折组的输血率更高（x2=8．479，P=0．004），多器官系统功能障碍评分（MODs）、炎症反应指标、局部缺氧和组织低灌注程度更高（均P〈0．05）。结论骨盆骨折会导致重度创伤患者院内预后严重不良，但其发病率不受年龄、性别、损伤机制和损伤严重程度的影响。同时骨盆骨折组患者的输血率更高，多器官系统功能障碍、炎症反应、局部缺氧和组织低灌注程度更高。ICU临床医师应当根据骨盆骨折患者的相关特点采取对应的急救措施，及时改善和稳定患者的总体状况。

Objective To evaluate the clinical features of patients with pelvic fractures and the influencing factors of pelvic fractures on in - hospital outcomes in patients with severe trauma. Methods A total of 293 patients with severe traumatic survival who were treated with orthopedic ICU in our hospital were selected. Patients were divided into pelvic fracture group （n = 106 ） and non - pelvic fracture group （ n = 187 ） based on whether or not the patient had a pelvic fracture. Propensity score matching （PSM） was used to match patients according to age, gender and ISS score. The clinical characteristics and laboratory indicators of the two groups were compared. The clinical characteristics of pelvic fractures and the impact of pelvic fractures on hospital outcomes in patients with severe trauma were analyzed. Results A total of 170 patients were matched with 85 patients in each group. After matching, there was no difference in age, gender, ISS score, and cause of injury between the two groups （ all P 〉 0.05）. However, length of ICU stay （ t = 10. 800, P 〈 0. 001 ） and total length of stay （ t = 11. 242, P 〈 0.001 ） were significantly increased in patients with pelvic fractures. It suggested that the incidence of pelvic fractures is not affected by age, gender, injury mechanisms, and severity of injury, but pelvic fractures can result in serious in - hospital prognosis. At the same time, the transfusion rate was higher in the pelvic fracture group （X2 = 8. 479, P = 0. 004）, and the multiple organ systemdysfunction score （MODs）, inflammatory response index, local hypoxia, and tissue hypoperfusion were all higher （ all P 〈 0.05 ）. Conclusion Pelvic fractures can result in serious adverse outcomes in patients with severe trauma, but their incidence is not affected by age, gender, injury mechanisms, and severity of injury. At the same time, patients in the pelvic fracture group have higher blood transfusion rates, multiple organ dysfunction, inflammatory reactions, hypoxia, and hypoperfusion. Clinicians working in ICU should take corresponding first - aid measures according to the relevant characteristics of patients with pelvic fractures to improve and stabilize the overall status of patients in a timely manner.