结合RTS和AIS-ISS评分探究高处坠落伤患者的胸部创伤临床特征和诊疗思路

Clinical characteristics and diagnostic approach of patients with high-level fall injuries combined with chest trauma:a study utilizing RTS and AIS-ISS scoring systems

目的结合修正创伤评分(RTS)和胸部创伤评分(AIS-ISS)探究合并胸部创伤的高处坠落伤患者的临床特征和诊疗思路。方法回顾性分析2020年12月至2023年6月期间于苏州市独墅湖医院(苏州大学附属独墅湖医院)就诊的137例患者,致伤因素为高处坠落且合并胸部损伤,其中有114例符合纳入标准,排除23例。男87例,年龄(40.44±10.23)岁;女27例,年龄(36.92±10.75)岁。根据RTS以及AIS-ISS针对其不同的临床特征和处理预后进行分析,旨在进一步探明高处坠落伤患者的创伤特点,提升诊疗效率和临床结局。结果高处坠落伤合并胸部创伤患者的RTS和AIS-ISS呈负线性相关,胸部创伤的治疗贯穿全病程,是影响临床预后的重要独立因素。RTS重伤组86.76%(59/68)高处坠落伤患者发生严重类型的胸部创伤或合并多种胸部创伤,其中合并四肢或脊柱骨折58例(85.29%,58/68)、颅脑损伤47例(69.11%,47/68)、腹腔脏器损伤25例(36.76%,25/68)、其他创伤26例(38.23%,26/68)。RTS轻伤组中严重类型胸部创伤或合并多种胸部创伤17例(36.95%,17/46),均合并颅脑损伤,此外,合并四肢或脊柱骨折17例(36.95%,17/46)、腹腔脏器损伤8例(17.39%,8/46)、其他创伤11例(23.91%,11/46)。结论高处坠落伤患者易合并多种胸部创伤或其他部位创伤,具有伤情复杂多变的特点,尤其是RTS重伤组患者出现严重类型的胸部创伤或合并多种胸部或其他病种的损伤均较RTS轻伤组中的比例明显升高,在临床诊疗中需额外重视给予胸部创伤全程管理可进一步提升患者预后。

Objective To investigate the clinical characteristics and diagnostic approach of patients with high-level fall injuries combined with chest trauma.Methods A retrospective analysis was conducted on 137 patients who sought medical treatment at Suzhou Dushu Lake Hospital(Dushu Lake Hospital Affiliated to Soochow University)between December 2020 and June 2023.These patients had sustained injuries from high-level falls with concurrent chest trauma.Among them,there were 87 male individuals with an average age of(40.44±10.23)years and 27 female individuals with an average age of(36.92±10.75)years.Among the patients,114 met the inclusion criteria,while 23 were excluded.The clinical characteristics and treatment outcomes were analyzed based on the Revised Trauma Score and chest trauma score in order to further investigate the trauma characteristics of patients with high-level fall injuries and enhance the efficiency of diagnosis,treatment,and clinical outcomes.Results There was a negative linear correlation between the Revised Trauma Score and chest trauma score in patients with high-level fall injuries combined with chest trauma.Chest trauma,requiring comprehensive management throughout the entire course of the disease,emerged as a significant independent factor affecting clinical prognosis.In the RTS severe injury group,the proportion of severe chest injuries or multiple injuries in patients with high-level fall injuries was 59/68(86.76%),with 47/68(69.11%)of patients experiencing concomitant head injuries,25/68(36.76%)experiencing abdominal organ injuries,58/68(85.29%)experiencing limb or spinal fractures,and 26/68(38.23%)having other types of injuries.In the RTS mild injury group,the proportion of severe chest injuries or multiple injuries was 17/46(36.95%),with 17/46(36.95%)of patients experiencing concomitant head injuries,8/46(17.39%)experiencing abdominal organ injuries,17/46(36.95%)experiencing limb or spinal fractures,and 11/46(23.91%)having other types of injuries.Conclusion Patients with high-level fall injuries are prone to multiple chest injuries or injuries in other regions,exhibiting complex and variable injury patterns.Particularly in the RTS severe injury group,the incidence of severe chest injuries or concomitant injuries in the chest or other regions is significantly higher compared to the RTS mild injury group.Therefore,comprehensive management of chest trauma should be prioritized throughout the clinical diagnosis and treatment process to further improve patient prognosis.