多发伤伴失血性休克患者急诊救治效果的影响因素研究

Study of the influencing factors of emergency treatment effect in patients with multiple trauma combined with hemorrhagic shock

目的探究多发伤伴失血性休克患者急诊救治效果的影响因素。方法本研究为病例系列分析研究,选取2020年1月至2022年12月南阳市第一人民医院急诊医学科收治的128例多发伤伴失血性休克患者,男65例,女63例,年龄(57.82±5.79)岁,年龄范围为46~70岁。所有患者均接受统一治疗措施,统计急诊救治效果,通过调查问卷方式收集调查其临床资料,采用logistic回归模型分析急诊救治效果的影响因素,并采用受试者操作特征(ROC)曲线分析影响因素预测预后的价值。结果128例多发伤伴失血性休克患者急诊救治效果良好率为87.5%(112/128);急诊救治效果良好患者的休克程度、病情程度均优于急诊救治效果差的患者,合并脊柱、四肢,受伤至救治时间≤1 h、有院外处理状况、年龄<60岁占比高于急诊救治效果差的患者,差异有统计学意义(P<0.05);logistic回归预测模型显示,年龄≥60岁,重度休克,重伤,受伤至救治时间>1 h、无院外处理状况及合并头颅、腹部、胸部损伤为多发伤伴失血性休克患者急诊救治效果差的独立危险因素(P<0.05);ROC曲线分析显示,logistic回归模型预测多发伤伴失血性休克患者急诊救治效果差的曲线下面积为0.929,95%CI为0.869~0.967,灵敏度为87.50%,特异度为84.82%(P<0.001)。结论多发伤伴失血性休克患者急诊救治效果受到高龄、重度休克、重伤、受伤至救治时间>1 h、无院外处理以及合并头颅、腹部和胸部等因素影响,按照以上因素构建logistic回归预测模型对于急诊救治效果差的发生具有良好预测价值,可为临床防治提供新途径。

Objective To explore the influencing factors of emergency treatment of multiple trauma patients with hemorrhagic shock.Methods This study was a case series analysis study,a total of 128 patients with multiple injuries and hemorrhagic shock in the department of Emergency Medicine of Nanyang First People′s Hospital from January 2020 to December 2022 were selected,including 65 males and 63 females,aged(57.82±5.79)years old,ranging from 46 to 70 years old.All patients received uniform treatment measures and were evaluated for emergency treatment efficacy.Clinical data were collected from patients through questionnaires,and logistic regression models were used to analyze the factors affecting emergency treatment efficacy.The value of the factors in predicting prognosis was analyzed using the receiver operating characteristic(ROC)curve.Results The effective rate of emergency treatment was 87.5%(112/128)in 128 patients with multiple injuries combined with hemorrhagic shock.The shock degree and condition degree of patients with good emergency treatment effect were better than those of patients with poor emergency treatment effect,good emergency treatment patients with spine and limbs,time from injury to treatment≤1 h,out-of-hospital treatment,and age<60 years old were higher than those of poor emergency treatment effect,the differences were statistically significant(P<0.05).The results of logistic regression prediction model showed that age≥60 years old,severe shock,severe injury,time from injury to treatment>1 h,no out-of-hospital treatment,and combined head,abdomen and chest were independent risk factors for poor emergency treatment effect in patients with multiple injuries combined with hemorrhagic shock(P<0.05).ROC curve analysis showed that the area under curve value of logistic regression model for predicting poor emergency treatment effect of multiple trauma patients with hemorrhagic shock was 0.929,95%CI was 0.869 to 0.967,the sensitivity was 87.50%,and the specificity was 84.82%(P<0.001).Conclusions The emergency treatment effect of multiple trauma patients with hemorrhagic shock is affected by factors such as advanced age,severe shock,severe injury,time from injury to treatment>1 h,no out-of-hospital treatment,and combined head,abdomen and chest.The logistic regression prediction model constructed according to the above factors has a good predictive value for the occurrence of poor emergency treatment effect.It can provide a new way for clinical prevention and treatment.