不同年龄组严重创伤患者的临床特点分析

Clinical characteristics of severe trauma in patients of different ages

目的 分析不同年龄组严重创伤患者的临床特点,以制订相应的预防、抢救及治疗措施,提高救治成功率。方法 回顾性分析1999年1月-2003年1月收治的1 246例严重创伤患者,分为4组:儿童组、青年组、中年组、老年组,将各组性别比例、致伤原因、伤后死亡时间、损伤严重程度评分(ISS)和格拉斯哥昏迷计分(GCS)与预后的关系进行比较。结果 各年龄组均以男性患者多见。致伤原因主要为交通伤,其次为坠落伤、钝锐器伤、跌伤等。全组患者伤后24 h内的死亡率为8.8％,24 h以后的死亡率为2.0％,老年组伤后24 h内的死亡率和青年组相比有显著性差异(P<0.01),24 h以后的死亡率和青年组相比有显著性差异(P<0.01),和中年组相比有差异(P<0.05)。ISS对预后的影响是计分越高,患者死亡的可能性越大,而GCS则正好相反,即计分越低,死亡率越高。老年组死亡患者的ISS和GCS与其他年龄组相比,有差异或显著性差异。结论 各年龄组严重创伤患者在性别比例、致伤原因、预后等方面具有不同的临床特点。ISS及GCS是判断创伤严重程度和预后较为客观的2个指标,抢救治疗以伤后24 h内尤其重要,对老年患者更应引起足够重视。

Objective To study the clinical characteristics of severe trauma in patients of different ages, there improving medical measures and increasing survival rate.Methods Retrospective analysis was made of 1 246 cases with sever trauma admitted from January 1999 to January 2003.They were divided into 4 groups (adolescent group, youth group, middle-aged group, elderly group) ,and compared with each other for sex ratio, causes of trauma, death time after trauma,and relationship of injury severity score(ISS) and Glasgow coma scale(GCS) and prognosis. Results The incidence of severe trauma all ages in the males was all higher than that in the females at all ages. The chief cause of trauma was traffic accident,followed by fall from height, blunt and sharp instrument injuryies.and tumble:blunt and sharp instrument injuries in youth group and middle-aged group were higher( P < 0.05) ,in 24 hours after trauma was 8.8% ,and over 24 hours after trauma was 2.0% . There were significant differences ( P < 0.01), in fatality within 24 hours and over 24 hours after trauma between elderly group and youth group and between elderly group and,middle- aged group ( P <0.05).The higher the ISS.the higher the probability of death, where as the lower the GCS, the higher the probability of death, in ISS and GCS of between the dead patients in elderly group and those in other groups . There were significant differences. Conclusions Patients with severe trauma of different ages have different clinical characteristics in sex ratio, cause of trauma and prognosis, ISS and GCS are two objective indices in judging degree of trauma severity and prognosis. Prompt treatment within 24 hours of severe trauma is very important; particular attention should paid to elderly patients.