多发伤患者住院期间危急值回顾性分析

A retrospective analysis of critical values of multiple trauma patients during hospitalization

目的探讨多发伤患者住院期间危急值出现特点及临床意义。方法收集华中科技大学同济医学院附属同济医院创伤外科2018年7月—2021年6月1034例危急值报告结果,分析危急值报告发生的时间、项目、异常值分布特点。结果2018年7月—2019年6月报道危急值项目382例,2019年7月—2020年6月报道230例,2020年7月—2021年6月报道422例,3年共报道1034例。这些危急值所涉及患者共计495人,男性367人,女性128人;患者年龄中位数52岁(39~62岁),损伤严重度评分中位数为24分(18~33分)。最近3年创伤外科住院患者危急值报告最常见时间段在08:00~15:59,例数占比65.18%~70.62%。在每个统计时间段内,超敏肌钙蛋白出现频次及所占比例均为最高,依次达54.97%、50.87%、68.96%。除2019年7月—2020年6月时间段外,出现例次高的危急值项目为血钾异常,高钾血症出现频次多于低钾血症(53例vs.21例)。与出血及凝血紊乱相关的危急值项目,如血红蛋白、血小板、凝血酶原时间、活化部分凝血活酶时间、国际标准化比值、纤维蛋白原,累计占比18.57%,异常指标主要提示重度贫血及低凝状态。微生物培养危急值共计67例,累计占比为6.48%。影像学危急值共计11例,其中肺栓塞数量最多(6例)。结论创伤外科的多发伤患者病情重,所产生的危急值项目种类广,需结合患者病情进行分析鉴别,及时采取预防和应对措施,阻止患者病情进一步恶化。

Objective To explore the clinical characteristics and significance of critical values of multiple trauma patients during hospitalization.Methods The critical value reports were collected from the Department of Traumatic Surgery of Tongji Hospital,from Jul.2018 to Jun.2021,to investigate the onset time,affected items and distribution characteristics.Results From Jul.2018 to Jun.2019,382 items with critical values were reported,230 from Jul.2019 to Jun.2020,and 422 from Jul.2020 to Jun.2021,altogether 1,034 items involving 495 patients within the three years.There were 367 males and 128 females.The median age was 52 years,range 39-62 years,and the median injury severity scale(ISS)was 24(18-33).During the study period,the most common onset time point of critical values in the traumatic inpatients was from 08:00 to 15:59,accounting for 65.18%-70.62%.In each analysis year,hypersensitive troponin was the most common item,reaching 54.97%,50.87%and 68.96%,respectively.The second common critical value item was blood potassium abnormality,except for the time period from Jul.2019 to Jun.2020.Hyperkalemia was more often than hypokalemia(53 cases vs.21 cases).The other items related to bleeding and coagulation disorders,such as hemoglobin,platelets,prothrombin time,activated partial thromboplastin time,international standardized ratio,and fibrinogen,combinedly accounted for 18.57%of total critical value projects,mainly indicating severe anemia and low coagulation.Microbial culture showed 67 critical values(6.48%).The imaging item showed 11 critical values,with pulmonary embolism being the majority(6/11).Conclusion Hospitalized multiple trauma patients are at serious conditions with frequent onset of critical phenomenon.It is necessary to timely analyze and identify the patients'conditions,and take preventive interventions to prevent further deterioration.