摘要
目的 探讨严重创伤患者发生急性呼吸窘迫综合征(ARDS)的相关危险因素。方法回顾性分析解放军总医院第四医学中心急救部2010年6月至2017年6月收治的308例严重创伤患者的临床资料,根据患者是否患有ARDS将其分为观察组(77例发生ARDS)和对照组(231例未发生ARDS);对比分析2组患者年龄、胸创伤严重程度评分(TTS)、基础性疾病、休克持续时间等。单因素分析和多因素分析判定严重创伤患者发生ARDS的危险因素。结果胸创伤的严重程度与ARDS的发生具有相关性,观察组机械通气率远高于对照组,差异有统计学意义(P<0.05)。2组患者的肺部感染发生率、EICU及住院天数、死亡率比较,差异具有统计学意义(P<0.05)。单因素分析显示,2组患者之间休克持续时间≥4h、TTS评分≥14分、并发肺部感染和既往糖尿病史比较,差异具有统计学意义(P<0.05)。Logistic回归分析示,TTS评分≥14分、休克持续时间≥4h、入院时低氧血症是创伤后ARDS的危险因素(P<0.01),其中TTS评分≥14分是其高危因素(P<0.01)。结论严重创伤患者发生ARDS与休克时间、TTS评分和入院时低氧血症相关。
Objective To investigate the risk factors for acute respiratory distress syndrome(ARDS)in patients with severe trauma.Methods Clinical data of 308 severe trauma patients admitted to the emergency department of the fourth medical center of PLA general hospital from June 2010 to June 2017 were retrospectively analyzed.And the patients were divided into the observation group(77 cases)and the control group(231 cases)according to whether they suffered from ARDS.Age,thoracic trauma severity(TTS),basic disease and shock duration were compared between the 2 groups.Univariate analysis and multivariate analysis were used to determine the risk factors of ARDS in patients with severe trauma.Results The severity of chest trauma is correlated with the occurrence of ARDS,and the mechanical ventilation rate in the observation group is much higher than that in the control group,with statistically significant difference(P<0.05).The incidence of pulmonary infection,length of EICU and hospital stay,and mortality of the two groups were statistically significant(P<0.05).Unifactorial analysis showed that shock duration greater than or equal to 4 hours,TTS score greater than or equal to 14 points,complicated with pulmonary infection,and previous history of diabetes were statistically significant between the two groups(P<0.05).Logistic regression analysis showed that TTS score greater than or equal to 14,shock duration greater than or equal to 4 hours and hypoxemia at admission were risk factors for ARDS after trauma(P<0.001),among which TTS score greater than or equal to 14 was the high risk factor(P<0.01).Conclusion ARDS in patients with severe trauma is associated with shock duration,TTS score and hypoxemia at admission.
作者
刘东昇
张婷
王曼
刘钧荣
刘红升
LIU Dong-sheng;ZHANG Ting;WANG Man;LIU Jun-Rong;LIU Hong-sheng(Emergency Department,Fourth Medical Center of PLA General Hospital,Beijing 100048,China;Clinical Laboratory,Fifth Medical Center of PLA General Hospital,Beijing 100071,China)
出处
《局解手术学杂志》
2019年第9期731-735,共5页
Journal of Regional Anatomy and Operative Surgery
基金
国家科学杰出青年基金(30125020)
军队“十二五”计划(AWS11J008)
关键词
严重创伤
急性呼吸窘迫综合征
危险因素
相关性
severe trauma
acute respiratory distress syndrome
risk factors
correlation
