严重多发伤患者重返EICU相关危险因素及预后分析

Analysis on related risk factor and prognosis of patients with severe multiple trauma returning to EICU

目的探讨严重多发伤患者重返急诊重症监护病房(EICU)危险因素及影响其预后的相关因素。方法收集2013年1月至2016年1月EICU 1 570例严重多发伤患者中重返EICU患者的资料,采用回顾性方法分析患者的重返原因,通过多因素Logistic回归分析确定重返EICU的独立危险因素。对重返EICU的多发伤患者采用COX回归模型进行生存分析。结果 48例严重多发伤患者重返EICU,病死率高于非重返患者(20.8%vs.6.9%),多因素Logistic回归分析显示,首次EICU住院时间及气管切开是多发伤患者重返EICU的独立危险因素。生存分析显示重返EICU患者的ICU生存时间显著低于未再入患者,COX回归分析发现首次入EICU时急性生理与慢性健康(APACHE)Ⅱ评分及多器官功能障碍综合征(MODS)是重返EICU死亡的独立危险因素。结论首次EICU住院时间及气管切开是严重多发伤患者重返EICU的独立危险因素,APACHEⅡ评分及MODS对重返EICU的多发伤患者预后有预测价值。

Objective To investigate the risk factors and related factors affecting prognosis in the patients with multiple trauma returning to emergency intensive care unit(EICU).Methods The data in 1 570 EICU cases of multiple trauma returning to EICU from January 2013 to January 2016 were collected.The returning causes were analyzed by adopting the retrospective analysis method.Then the independent risk factors for returning to EICU were determined by the multivariate Logistic regression analysis.The patients with multiple trauma returning to EICU were performed the survival analysis by adopting the COX regression model.Results There were 48 cases(3.1%)of multiple trauma returning to EICU.Their death rate was higher than that of the patients without returning to EICU(20.8%vs.6.9%,P<0.05).The multivariate Logistic regression analysis showed that the first time EICU stay time and tracheotomy were the independent risk factors for returning to EICU.The survival analysis showed that the ICU survival time in the patients returning to EICU was significantly lower than that in the patients without returning to EICU.The COX regression analysis found that the high APACHEⅡscore and MODS at the first time admission to EICU were the independent risk factors for returning to EICU.Conclusion The first time EICU stay time and tracheotomy are the independent risk factors for returning to EICU in the patients with multiple trauma.