急诊创伤全身麻醉手术患者院内死亡的危险因素分析

Risk factors for death in trauma patients after surgery under general anesthesia

目的探讨急诊创伤全身麻醉手术患者术后早期死亡的相关危险因素,以助于预测全身麻醉下急诊创伤患者的预后,并为临床干预提供依据。方法通过医院信息系统和手术麻醉信息系统数据库,收集2019年1月1日-2020年12月31日期间接受全身麻醉手术的急诊创伤患者的基本信息、相关围手术期管理信息,按患者入院7 d内是否死亡并以年龄、性别、创伤手术类型为匹配变量进行匹配得到病例组和对照组。运用单因素分析法和多因素二分类logistic回归模型进行院内死亡的危险因素分析。结果患者共2532例,排除96例转归信息不明者,共2436例患者纳入研究,其中入院7 d内死亡19例。经倾向性评分匹配,病例组纳入19例患者,对照组纳入95例患者。多因素logistic回归分析结果显示,入院昏迷状态[比值比(odds ratio,OR)=9.961,95%置信区间(confidence interval,CI)(1.352,73.363),P=0.024]、围手术期体温<36℃[OR=23.052,95%CI(1.523,348.897),P=0.024]、术中平均动脉压<60 mm Hg(1 mm Hg=0.133 kPa)[OR=12.158,95%CI(1.764,83.813),P=0.011]、血清钙<2.0 mmol/L[OR=33.853,95%CI(2.530,452.963),P=0.008]、凝血酶原时间[OR=1.048,95%CI(1.002,1.096),P=0.042]均能显著增加急诊创伤全身麻醉手术患者7 d内死亡风险。结论院前昏迷、凝血功能障碍、围手术期低体温、术中低血压、低钙是急诊创伤全身麻醉手术患者院内死亡的独立危险因素。

Objective To explore the risk factors for death within 7 days after admission in trauma patients undergoing surgery under general anesthesia,and provide evidence for predicting the outcomes of those patients and guidance for clinical practices.Methods The basic information and perioperative data of trauma patients who underwent surgery under general anesthesia between January 1 st 2019 and December 31 st 2020 were collected from the Hospital Information System and the Anesthesia Information Management System.Patients who died within 7 days after admission were assigned into the case group and the others were assigned into the control group,and then propensityscore matching method was used based on age,sex,and injury types.Univariate analyses and multivariate binary logistic regression analysis were used to identify the risk factors for death within 7 days after admission in these patients.Results There were 2532 patients who met the inclusion criteria,of whom 96 patients with missing follow-up information were excluded,and 2436 patients remained for the study.After propensity-score matching,there were 19 patients in the case group and 95 patients in the control group.The result of multivariate logistic regression analysis showed that the coma state at admission[odds ratio(OR)=9.961,95%confidence interval(CI)(1.352,73.363),P=0.024],perioperative body temperature<36℃[OR=23.052,95%CI(1.523,348.897),P=0.024],intraoperative mean arterial pressure<60 mm Hg(1 mm Hg=0.133 kPa)[OR=12.158,95%CI(1.764,83.813),P=0.011],serum calcium concentraion<2.0 mmol/L[OR=33.853,95%CI(2.530,452.963),P=0.008],and prothrombin time[OR=1.048,95%CI(1.002,1.096),P=0.042]increased the risk of death within 7 days after admission.Conclusion The coma state,coagulopathy,perioperative hypothermia,intraoperative hypotension,and hypocalcemia are 5 independent risk factors for death in trauma patients after surgery under general anesthesia.