143例ICU老年创伤患者的流行病学分析

Epidemiological characteristics of 143 elderly trauma patients in intensive care unit

目的探讨单中心老年创伤重症患者流行病学特点,为临床救治提供参考。方法回顾性分析2017年1月至2018年6月陆军军医大学大坪医院重症医学科(ICU)收治的65岁以上老年创伤患者143例,分析患者性别、年龄、致伤机制、损伤严重程度评分(ISS)、并发症、住院时间等资料。采用Mann-Whitney检验比较ISS评分、急性生理与慢性健康评分(APACHE Ⅱ评分)、ICU时间、住院时间在不同受伤机制和不同年龄之间的差异,使用Pearson χ^2检验比较年龄分层计数、基础疾病分类计数、好转出院例数在不同受伤机制和不同年龄之间的差异,应用Logistic回归分析法分析并发症发生的危险因素。结果所有创伤患者中,男性患者71例(49.65%,71/143),女性72例(50.34%,72/143);年龄65~99岁,平均年龄(78±1)岁;多发伤43例(30.07%,43/143),单部位伤100例(69.93%,100/143)。跌倒伤是首位致伤原因90例(62.94%,90/143),其次为车祸伤40例(27.97%,40/143)。跌倒伤ISS[9(9,9)分vs 22(16,27)分,Z=7.574,P<0.001]、APACHE Ⅱ评分[15(14,17)分vs 17(15,21)分,P=0.001]均较低,住ICU时间[2(1,3)d vs 8(1,16)d,Z=4.407,P<0.001]和住院时间[(16(12,22.25)d vs 30(19,49)d,Z=4.779,P<0.001)]较非跌倒伤更短,好转出院率比较差异无统计学意义(P>0.05)。≥80岁患者与<80岁患者比较,APACHE Ⅱ评分明显升高[16(15,20)分vs 14(15,18)分,Z=2.093,P=0.036)],住ICU的时间更长[3(1,10)d vs 1(1,7.5)d,Z=2.013,P=0.044]。APACHE Ⅱ评分是并发症发生的危险因素(OR=1.771,P=0.01)。结论老年患者入住ICU的主要原因是跌倒伤,其次是车祸伤。除年龄外,APACHE Ⅱ评分高时,住ICU时间更长和并发症发生率更高。

Objective To investigate the epidemiological characteristics of elderly critical trauma patients in a single center to provide a reference for clinical treatment. Methods The clinical data of 143 elderly patients (age 65 years or older) admitted to Daping Hospital from January 2017 to June 2018 were collected. The patient's gender, age, mechanism of injury, injury severity score (ISS), pre-existing medical conditions, and hospital length of stay were analyzed. The Mann-Whitney test was utilized to compare the differences in ISS score, APACHE Ⅱ score, ICU time, and hospital stay between different injury mechanisms and ages. The Pearson χ^2 test was used to compare age stratification, underlying disease classification, and number of cases with condition improvement and discharge between different injury mechanisms and ages. Logistic regression analysis was utilized to analyze the risk factors for complications. Results There were 71 male cases (49.65%, 71/143) and 72 females (50.34%, 72/143). The patients ranged in age from 65 to 99 years, with a mean age of (78±1) years. Of all cases, 43 (30.07%, 43/143) had multiple injuries and 100 (69.93%, 100/143) had single-site injuries. Tumble injuries were the first cause of injury (62.94%, 90/143), followed by traffic accidental injuries (27.97%, 40/143). Compared with non-tumble injuries, the ISS [9 (9, 9) vs 22 (16, 27), Z=7.574, P<0.001] and APACHE Ⅱ scores [15 (14, 17) vs 17 (15, 21), P=0.001] of tumble injuries were significantly lower, but the ICU time [2(1, 3) d vs 8 (1, 16) d, Z=4.407, P<0.001] and hospital stay [16 (12, 22.25) d vs 30 (19, 49) d, Z=4.779, P<0.001] were significantly shorter, although there was no significant difference in the rate of improvement and discharge (P>0.05). Patients with an age of 80 or older had a higher APACHE Ⅱ score [16 (15, 20) vs 14 (15, 18), Z=2.093, P=0.036)] and longer stay in the ICU [3 (1, 10) d vs 1 (1, 7.5) d, Z=2.013, P=0.044]. Regression analysis showed that APACHE Ⅱ score was a risk factor associated with complications (OR=1.771, P=0.01). Conclusions The main reason for elderly trauma patients to stay in the ICU is tumble injuries, followed by traffic accident injuries. In addition to age, patients with a high APACHE Ⅱ score have longer ICU stays and a higher complication rate.