多发伤并发持续炎症-免疫抑制-分解代谢综合征患者的临床特征及预后分析

A prospective study of clinical characteristics and prognosis in patients with persistent inflammation,immunosuppression and catabolism syndrome after polytrauma

目的研究多发伤并发持续炎症-免疫抑制-分解代谢综合征(persistent inflammation, immunosuppression and catabolism syndrome, PICS)患者的临床特征及预后。方法分析2019年1月至2020年7月间收治于同济医院创伤外科的1 083例多发伤患者的临床资料,排除年龄<18岁,住院时间<15 d,以及既往有恶性肿瘤,免疫性、消耗性、代谢性疾病史的患者。依PICS诊断标准将患者分为PICS组与N-PICS组(不伴PICS)。收集患者的临床特征及预后,以及ISS评分、GCS评分及SOFA评分等资料,通过t检验或χ^(2)检验比较两组间差异。结果多发伤患者的PICS发生率为11.7%(127/1 083)。PICS患者以中老年男性为主,68.5%伴颅脑损伤,59%伴胸部损伤,其GCS评分更低,而ISS、APACHEⅡ及SOFA评分更高,与不伴PICS的患者相比差异有统计学意义(P <0.01或P<0.05)。PICS患者79.5%使用机械通气,76.3%伴肺部感染,其28 d病死率为5.5%,180 d病死率为16.5%,与不伴PICS的患者相比差异有统计学意义(P<0.01)。结论多发伤后PICS发生率较高,常见于伴发颅脑和(或)胸部创伤的中老年男性严重多发伤患者。伴发PICS的多发伤患者中长期预后不良,临床上应加强早期识别与干预。

Objective To prospectively assess clinical characteristics,potential causes and prognosis in patients with persistent inflammation,immunosuppression and catabolism syndrome(PICS)after polytrauma.Methods Totally 1083 patients with polytrauma admitted to Department of Traumatic Surgery of Tongji Hospital from Janury 2019 to July 2020 were enrolled.Exclusion criteria included age<18 years old,length of hospital stay<15 days,previous medical history of malignancy,or immunological,consumptive,and metabolic diseases.According to the diagnostic criteria of PICS,all enrolled patients were divided into two groups:PICS group and N-PICS group(without PICS).The patient’s clinical characteristics,ISS score,GCS score,SOFA score,and prognosis were collected.The χ^(2) test or Student’s t test was uesd to compare the difference between the PICS group and N-PICS group.Results The incidence of PICS in patients with polytrauma was 11.7%(127/1083).The majority of PICS patients were middle-aged and elderly men,68.5%with traumatic brain injury and 59%with thoracic injury.GCS score was significantly lower,while ISS,APACHE II and SOFA scores were significantly higher in the PICS group than in the N-PICS group(P<0.01,P<0.05).Among PICS patients,79.5%were treated with mechanical ventilation and 76.3%were associated with pulmonary infection,with a 28-day mortality of 5.5%and a 180-day mortality of 16.5%,which were siginifcantly different from those without PICS.Conclusions PICS has a high incidence after polytrauma and is commonly seen in middle-aged and elderly male patients with severe polytrauma,especially accompanied by traumatic brain injury or/and thoracic injury.Patients with PICS after polytrauma have poor long-term prognosis,so early identification and intervention should be strengthened in clinical practice.