重症胸部创伤合并创伤性休克患者预后及相关因素分析

Analysis of Prognosis and Related Factors in Patients With Severe Thoracic Trauma and Traumatic Shock

目的研究重症胸部创伤(SCT)合并创伤性休克(TS)患者早期凝血功能、血清炎症因子及热休克蛋白70(HSP-70)水平变化及与预后的相关性。方法选取2016年7月-2019年7月本院SCT合并TS患者80例临床资料进行回顾性分析,采集患者入院即刻肘静脉血并检测凝血功能、炎症因子和HSP-70,同时以ICU死亡为结局随访患者预后,根据随访结果将患者分为生存组49例和死亡组31例,比较两组各项指标差异并分析其对患者预后的影响。结果 80例SCT并TS患者患者ICU期间死亡31例,死亡率为38.75%,死亡组患者APTT、PT和D-D高于生存组,FIB低于生存组,差异有统计学意义(P <0.05);血清IL-17、TNF-α和CRP水平高于生存组,血清HSP-70水平低于生存组,差异有统计学意义(P <0.05);Logistic回归分析显示D-D、FIB、IL-17和TNF-α是SCT并TS患者死亡的独立危险因素(P <0.05),HSP-70是重要保护因素(P <0.05)。结论凝血功能紊乱和炎症因子是导致SCT并TS患者预后不良的重要危险因素,HSP-70则对防止患者死亡具有一定保护作用。

Objective To study the early coagulation function in patients with severe thoracic trauma(SCT) and traumatic shock(TS), Changes of serum inflammatory factors and heat shock protein 70(HSP-70) levels and their correlation with prognosis. Methods From July 2016 to July 2019, 80 patients with SCT and ts in our hospital were selected for retrospective analysis. Elbow vein blood was collected immediately after admission and coagulation function, inflammatory factors and HSP-70 were detected. At the same time, patients were followed up with the outcome of ICU death. According to the follow-up results, patients were divided into survival group(49 cases) and death group(31 cases). The differences of each index between the two groups were compared and analyzed Post impact. Results Thirty-one patients died during ICU in 80 patients with SCT and TS,The mortality rate was 38.75%,APTT, PT and D-D in the dead group were higher than those in the survival group,FIB was lower than survival group,The difference was significant(P < 0.05);Serum levels of IL-17, TNF-alpha and CRP were higher in survival group than in survival group, Serum HSP-70 level was lower than survival group,The difference was significant(P < 0.05);Logistic regression analysis showed that D-D, FIB, IL-17 and TNF-alpha were independent risk factors for death in patients with SCT and TS(P < 0.05). HSP-70 was an important protective factor(P < 0.05). Conclusion Coagulation dysfunction and inflammatory factors are important risk factors for poor prognosis in patients with SCT and TS, HSP-70 has a protective effect on preventing death of patients.