摘要
目的研究多发伤患者伤后不同时期的休克发生类型及特征。方法回顾性研究2020年6月至2021年12月间收治于多家创伤中心的多发伤患者,入选年龄>18岁多发伤患者;排除受伤到入组时间>48 h,及有恶性肿瘤史,慢性消耗性、代谢性或免疫性疾病史者。伤后48 h内为伤后早期,伤后48 h至14 d内为伤后中期。收集患者疾病史、临床表现、实验室检验、影像学检查、损伤严重度评分、格拉斯哥昏迷评分等资料,依据各休克类型的诊断标准,观察多发伤后不同时期休克的发生类型及特征。通过t检验、χ^(2)检验或Mann-WhitneyU检验比较组间差异。结果多发伤后早期、中期休克发生率分别为73.1%、36.4%,组间比较差异有统计学意义(P<0.01)。在伤后早期、中期两组中,低血容量性休克(hypovolemic shock,HS)患者(83.6%vs.28.4%)、分布性休克(distributed shock,DS)患者(13.7%vs.80.9%)、心源性休克患者(3.5%vs.6.6%)的占比,组间比较差异均有统计学意义(均P<0.05);梗阻性休克(obstructive shock,OS)患者占比(8.4%vs.9.7%),差异无统计学意义(P>0.05);病因不明型休克占比分别为1.6%、1.2%。多因型休克在伤后早期、中期占比分别为9.5%与14.4%。伤后不同时期多因型休克共观察到7种病因组合,伤后早期以HS+DS最为常见(42.3%),其次为HS+OS(28.8%);伤后中期以HS+DS最为常见(48.6%),其次为DS+OS(24.3%)。结论多发伤后休克发生率高,患者不同类型的休克可能同时存在或序贯发生,在制定休克复苏策略时应更加全面,以期提高多发伤的救治成功率。
Objective To investigate the types,incidences,and clinical characteristics of shock in polytrauma patients at different stages after polytrauma.Methods A retrospective study was conducted on polytrauma patients admitted to multiple trauma centers from June 2020 to December 2021.The inclusion criteria were patients>18 years old and treated due to polytrauma.Exclusion criteria included an admission time of more than 48 h after trauma,a history of malignancy,or metabolic,consumptive,and immunological diseases.The early stage was defined as the period of≤48 h after polytrauma,and the middle stage was defined as the period between 48 h and 14 days.The patient’s medical history,clinical manifestations,laboratory tests,imaging examination,injury severity score(ISS),and Glasgow coma scale(GCS)were collected.The types,incidences,and clinical characteristics of shock in different stages after polytrauma were analyzed,according to the diagnostic criteria of each type of shock.The differences between the groups were compared by Student’s t test,χ^(2) test or Mann-Whitney U test.Results The incidence of the early and middle stage shock after polytrauma were 73.1%and 36.4%,respectively,with statistically significant difference between stages(P<0.01).There were significant differences in the incidence of hypovolemic shock(83.6%vs.28.4%),distributed shock(13.7%vs.80.9%)and cardiogenic shock(3.5%vs.6.6%)between stages(all P<0.05).The incidence of obstructive shock(8.4%vs.9.7%,P>0.05)was similar between stages.The incidence of undifferentiated shock was 1.6%and 1.2%,respectively.There were 9.5%patients with multifactorial shock in the early stage and 14.4%in the middle stage.Totally 7 combinations of multifactorial shock were found in different stages after polytrauma.In the early stage,the combination of HS and DS accounted the highest ratio(42.3%)and followed by HS and OS for 28.8%.In the middle stage,the combination of HS and DS was the most common(48.6%)and followed by DS and OS(24.3%).Conclusions The incidence of shock
作者
罗家柳
唐良晟
陈登
邓海
杨净植
常特定
程晶
徐化强
何苗勃
万冬丽
张飞宇
吴梦帆
刘青云
隗世波
汪文国
殷刚
唐朝晖
Luo Jialiu;Tang Liangsheng;Chen Deng;Deng Hai;Yang Jingzhi;Chang Teding;Cheng Jing;Xu Huaqiang;He Miaobo;Wan Dongli;Zhang Feiyu;Wu Mengfan;Liu Qingyun;Wei Shibo;Wang Wenguo;Yin Gang;Tang Zhaohui(Department of Traumatic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Emergency Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Intensive Care Unit,Suizhou Central Hospital,Hubei University of Medicine,Suizhou 441300,China;Department of Traumatic Surgery,Tianmen First People’s Hospital,Tianmen 417300,China;Intensive Care Unit,Hanyang Hospital,Wuhan University of Science and Technology,Wuhan 430051,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2023年第1期70-75,共6页
Chinese Journal of Emergency Medicine
基金
国家自然科学基金(81873870)。
