血流动力学不稳定骨盆骨折流行病学特征及死亡危险因素分析

Analysis of Epidemiological Characteristics and Risk Factors of Hemodynamically Unstable Pelvic Fracture

目的研究血流动力学不稳定骨盆骨折患者流行病学特征及死亡危险因素。方法回顾性分析2017年1月~2020年12月收治于河北医科大学第三医院急诊重症监护病房(EICU)的102例血流动力学不稳定骨盆骨折患者的流行病学特征;根据住院28d内预后情况,将患者分为存活组和死亡组,比较两组一般临床资料、实验室检查指标及相关治疗情况,找出影响患者死亡的独立危险因素;绘制ROC曲线,计算曲线下面积(AUC)及独立危险因素的最佳临界值(cut-off)。结果最终102例患者纳入研究,存活组82例,死亡组20例。男73例,女29例,平均年龄49.01±15.83岁;以交通事故伤(60.8%)为主;24h内大量输血组ISS评分高于未大量输血组,死亡组ISS评分明显高于存活组(P<0.05);所有患者均有合并伤,以颅脑损伤、胸部损伤及腹部脏器损伤为主;logistic回归分析提示年龄、ISS评分、SOFA评分、肌酐(Cr)水平为患者死亡的独立危险因素。ROC分析显示年龄、ISS评分、SOFA评分、Cr水平曲线下面积分别为:0.655、0.731、0.908、0.799;最佳cut-off值分别为:48.5岁、27.5分、11.5分、105.8 umol/L。结论血流动力学不稳定骨盆骨折患者多为中年男性,以交通事故伤为主,且大部分均有合并伤;年龄、ISS评分、SOFA评分及Cr水平升高为血流动力学不稳定骨盆骨折患者死亡的独立危险因素。

Objective To study the epidemiological characteristics and risk factors in patients with hemodynamically unstable pelvic fracture.Methods The epidemiological characteristics of 102 patients with hemodynamically unstable pelvic fractures admitted to the emergency intensive care unit(EICU)of the Third Hospital of Hebei Medical University from January 2017 to December 2020 were analyzed,retrospectively.According to the outcome during hospitalization,the patients were divided into survival group and non-survival group.The demographic data,laboratory indexes and related treatment of the two groups were compared.The univariate analysis and multivariable analysis were conducted to analyse the risk factors.Through the receiver operating characteristic analysis(ROC),calculate the area under the ROC curve,and calculate the optimum cut-off value for risk data factors.Results 102 patients were included in the study(73 males and 29 females).There were 82 cases in the survival group and 20 cases in the non-survival group,the average age was 49.01±15.83 years old.Traffic accident injuries(60.8%)were most common..All patients had combined injuries,mainly were craniocerebral injury,chest injury and abdominal organ injury.Logistic analysis found four risk factors:age,ISS,SOFA,and Cr.ROC analysis showed the AUC of age,ISS,SOFA,Cr were 0.655,0.731,0.908,0.799.The best cut-off values were:48.5 years old,27.5 points,11.5 points and 105.8 umol/L.Conclusions Most of the patients with hemodynamically unstable pelvic fractures were middle-aged men,mainly causes of injury were traffic accident injuries.The higher the ISS score,the higher the possibility of massive blood transfusion within 24 hours of admission,and the worse the outcome.Patients were all complicated with injuries in other parts of the body.Age,ISS,SOFA and Cr are risk factors for death in patients with hemodynamically unstable pelvic fractures.