摘要
目的探讨严重多发伤患者脓毒症发生的相关危险因素,并分析各危险因素对严重多发伤患者脓毒症发生的预警效能。方法采用回顾性队列研究分析2019年7月至2021年10月余姚市人民医院收治的92例严重多发伤患者的临床资料,其中男71例,女21例;年龄36~55岁[(45.5±13.6)岁]。损伤严重度评分(ISS)20~29分[(25.3±6.4)分]。根据患者住院期间是否发生脓毒症,将患者分为脓毒症组(32例)和非脓毒症组(60例)。记录两组患者性别、年龄、基础疾病、致伤原因、损伤部位数、ISS、伤后并发症,以及伤后1,3,5 d芳香烃受体(AHR)、C‑反应蛋白(CRP)和降钙素原(PCT)水平。采用单因素分析评估上述指标与严重多发伤患者脓毒症发生的相关性;采用多因素Logistic回归分析确定严重多发伤患者伤后脓毒症发生的独立危险因素。采用受试者工作特征(ROC)曲线下面积(AUC)评估相关危险因素单独或联合对严重多发伤患者伤后脓毒症发生的预警效能。结果单因素分析结果显示,ISS、伤后1 d AHR水平、伤后3 d CRP和伤后3 d PCT水平与脓毒症发生有一定的相关性(P<0.05或0.01);而性别、年龄、基础疾病、致伤原因、损伤部位数、伤后并发症、伤后3,5 d AHR水平、伤后1,5 d CRP水平和伤后1,5 d PCT水平与脓毒症发生不相关(P均>0.05)。多因素Logistic回归分析结果表明,高ISS(OR=1.12,95%CI 1.01,1.24,P<0.05)、伤后1 d AHR水平(OR=1.30,95%CI 1.10,1.52,P<0.01)、伤后3 d PCT水平(OR=1.81,95%CI 1.08,3.03,P<0.05)与脓毒症发生显著相关。ROC曲线分析结果表明,高ISS(AUC=0.69,95%CI 0.57,0.76)和伤后1 d AHR水平(AUC=0.79,95%CI 0.68,0.90)对脓毒症发生有预警价值,两者联合的预警效能更优(AUC=0.86,95%CI 0.77,0.95)。结论高ISS、伤后1 d AHR水平、伤后3 d PCT水平是严重多发伤患者脓毒症发生的独立危险因素,伤后ISS、AHR及两者联合对严重多发伤患者伤后脓毒症的发生有较好的预警价值。
Objective To investigate the risk factors and their warning value for the occurrence of sepsis in patients with severe multiple trauma.Methods A retrospective cohort study was conducted to analyze the clinical data of 92 patients with severe multiple trauma admitted to Yuyao People′s Hospital from July 2019 to October 2021.There were 71 males and 21 females,with the age range of 36‑55 years[(45.5±13.6)years].The injury severity score(ISS)was 20‑29 points[(25.3±6.4)points].The patients were divided into sepsis group(n=32)and non‑sepsis group(n=60)according to whether sepsis occurred during hospitalization.Data were recorded for the two groups,including gender,age,basic diseases,cause of injury,number of injury sites,ISS,post‑injury complications,and levels of aryl hydrocarbon receptor(AHR),C‑reactive protein(CRP)and procalcitonin(PCT)at 1,3 and 5 days after injury.The above data were analyzed to identify their correlation with the occurrence of sepsis in patients with severe multiple trauma by univariate analysis.The independent risk factors for sepsis in patients with severe multiple trauma were determined by multivariate Logistic regression analysis.The warning value of the single or combined risk factors for the occurrence of sepsis in patients with severe multiple trauma was evaluated by the receiver operating characteristic(ROC)curve and area under the curve(AUC).Results By univariate analysis,it was demonstrated that the occurrence of sepsis was correlated with ISS,level of AHR at day 1 after injury,level of CRP at day 3 after injury and level of PCT at day 3 after injury(P<0.05 or 0.01),but not with age,sex,basic diseases,level of AHR at 3,5 days after injury,level of PCT at 1,5 days after injury and level of CRP at 1,5 days after injury(all P>0.05).By multivariate Logistic regression analysis,higher ISS(OR=1.12,95%CI 1.01,1.24,P<0.05),level of AHR at day 1 after injury(OR=1.30,95%CI 1.10,1.52,P<0.01)and level of PCT at day 3 after injury(OR=1.81,95%CI 1.08,3.03,P<0.05)were found to be strongly correlated with the occurrence of sepsis.ROC curve analysis showed that higher ISS(AUC=0.69,95%CI 0.57,0.76)and level of AHR at day 1 after injury(AUC=0.79,95%CI 0.68,0.90)had warning value for the occurrence of sepsis,and the warning efficiency of combined panel was much better(AUC=0.86,95%CI 0.77,0.95).Conclusions Higher ISS,level of AHR at day 1 after injury and level of PCT at day 3 after injury are independent risk factors for the occurrence of sepsis in patients with severe multiple trauma.ISS,AHR and combination of both exhibit good warning value for the occurrence of sepsis in patients with severe multiple trauma.
作者
孙淑英
文大林
陈国昇
王茉莉
赵晓东
高楚
毛盛尧
金平
汪正权
张安强
李子龙
Sun Shuying;Wen Dalin;Chen Guosheng;Wang Moli;Zhao Xiaodong;Gao Chu;Mao Shengyao;Jin Ping;Wang Zhengquan;Zhang Anqiang;Li Zilong(Health Science Center,Ningbo University,Ningbo 315000,China;Department of Emergency,Yuyao People′s Hospital,Yuyao 315400,China;Department of Wound Care Center,State Key Laboratory of Trauma,Burns and Combined Injury,Daping Hospital,Army Medical University,Chongqing 400042,China;Department of Emergency Surgery,Affiliated Hospital of Guizhou Medical University,Guiyang 550004,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2023年第5期443-449,共7页
Chinese Journal of Trauma
基金
国家自然科学基金(81971830)
创伤、烧伤和复合伤国家重点实验室优秀青年项目(SKLYQ202102)
创伤、烧伤和复合伤国家重点实验室开放项目(SKLKF202207)。
关键词
多处创伤
脓毒症
芳香烃受体
Multiple trauma
Sepsis
Aryl hydrocarbon receptor