急诊骨盆骨折伴多发伤患者接诊途中死亡的危险因素Logistic回归分析
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摘要
目的分析急诊骨盆骨折伴多发伤患者接诊途中死亡的危险因素。方法选取2016年6月至2017年12月医院急诊科收治的89例骨盆骨折伴多发伤患者为研究对象,根据患者接诊途中是否死亡,分为生存组(74例)与死亡组(15例)。收集患者的临床资料,比较快速急诊内科评分(REMS)与损伤严重程度(ISS)评分,并对影响急诊骨盆骨折伴多发伤患者接诊途中死亡的危险因素进行分析。结果死亡组患者入院前REMS、ISS评分均高于生存组(P<0.05)。死亡组15例患者中,死于失血性休克者8例,死于重度颅脑损伤者4例,死于肝脾破裂者3例。死亡组出血量>2 000 m L、合并失血性休克、合并多脏器损害、合并颅脑损伤、救护时间>1 h的占比均高于生存组(P<0.05);Logistic回归分析结果显示,上述因素均为急诊骨盆骨折伴多发伤患者接诊途中死亡的独立危险因素(P<0.05)。结论出血量、失血性休克、多脏器损害、颅脑损伤、救护时间均是导致急诊骨盆骨折伴多发伤患者接诊途中死亡的高危因素。针对具有上述因素的高危患者,在接诊途中实施快速、高效的救护处理是降低其死亡风险的关键。
Objective To analyze the risk factors of death on the way of emergency reception in pelvic fracture with multiple injuries patients. Methods A total of 89 cases of pelvic fracture with multiple injuries in emergency department of hospital from June 2016 to December 2017 were selected as the research objects. According to whether the patients died on the way of emergency reception, they were divided into survival group(74 cases) and death group(15 cases). The clinical data of patients were collected, and their rapid emergency internal medicine score(REMS) and severity of injury score(ISS)were compared. The risk factors of death on the way of emergency reception in pelvic fracture with multiple injuries patients were analyzed. Results Before admission, the scores of REMS and ISS in the death group were higher than those in the survival group(P<0.05). Of the 15 patients in the death group, 8 cases death of hemorrhagic shock, 4 cases death of severe craniocerebral injury and 3 cases death of rupture of liver and spleen. The proportion of bleeding >2 000 mL, with hemorrhagic shock, with multiple organ damage, with craniocerebral injury and rescue time >1 h in the death group were higher than those in the survival group(P<0.05). Logistic regression analysis showed that all the above factors were the independent risk factors of death on the way of emergency reception in pelvic fracture with multiple injuries patients(P<0.05).Conclusion Bleeding amount, hemorrhagic shock, multiple organ damage, craniocerebral injury and rescue time were highrisk factors of death on the way of emergency reception for pelvic fracture with multiple injuries. For high-risk patients with the above factors, the key to reduce the risk of death is to implement rapid and efficient rescue treatment on the way of emergency reception.
Objective To analyze the risk factors of death on the way of emergency reception in pelvic fracture with multiple injuries patients. Methods A total of 89 cases of pelvic fracture with multiple injuries in emergency department of hospital from June 2016 to December 2017 were selected as the research objects. According to whether the patients died on the way of emergency reception, they were divided into survival group(74 cases) and death group(15 cases). The clinical data of patients were collected, and their rapid emergency internal medicine score(REMS) and severity of injury score(ISS)were compared. The risk factors of death on the way of emergency reception in pelvic fracture with multiple injuries patients were analyzed. Results Before admission, the scores of REMS and ISS in the death group were higher than those in the survival group(P<0.05). Of the 15 patients in the death group, 8 cases death of hemorrhagic shock, 4 cases death of severe craniocerebral injury and 3 cases death of rupture of liver and spleen. The proportion of bleeding >2 000 mL, with hemorrhagic shock, with multiple organ damage, with craniocerebral injury and rescue time >1 h in the death group were higher than those in the survival group(P<0.05). Logistic regression analysis showed that all the above factors were the independent risk factors of death on the way of emergency reception in pelvic fracture with multiple injuries patients(P<0.05).Conclusion Bleeding amount, hemorrhagic shock, multiple organ damage, craniocerebral injury and rescue time were highrisk factors of death on the way of emergency reception for pelvic fracture with multiple injuries. For high-risk patients with the above factors, the key to reduce the risk of death is to implement rapid and efficient rescue treatment on the way of emergency reception.
引文
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[9]CHOI W,RHEE H,CHUNG E.Lower urinary tract imaging in pelvic fracture:an 11-year review of genitourinary complications and clinical outcomes[J].ANZ J Surg,2017,87(4):257-261.
[10]侯志勇,尚帅.不稳定骨盆骨折急诊救治中的争议问题[J].中华创伤杂志,2017,33(10):865-867.
[11]杨洪昌,陈仲,陈戈,等.合并开放性骨盆骨折严重多发伤的急诊处置[J].中华创伤杂志,2016,32(2):158-160.
[2]江利冰,蒋守银,赵小纲,等.世界急诊外科学会骨盆骨折分型及处理指南[J].中华急诊医学杂志,2017,26(3):268-269.
[3]符江.骨盆骨折伴直肠肛管损伤患者死亡风险调查及急诊处理研究[J].结直肠肛门外科,2016,22(4):391-394.
[4]佟梦琦,白颖,王姗,等.严重创伤伴骨盆骨折患者预后的危险因素分析[J].贵州医科大学学报,2017,42(11):1357-1362.
[5]陈仲,吴照祥.骨盆骨折的急诊处理[J].创伤外科杂志,2016,18(4):193-195.
[6]韦功滨,高劲谋,胡平,等.骨盆骨折大出血伴凝血病的救治策略[J].创伤外科杂志,2016,18(11):648-651.
[7]SWAID F,PELEG K,ALFICI R,et al.A comparison study of pelvic fractures and associated abdominal injuries between pediatric and adult blunt trauma patients[J].J Pediatr Surg,2017,52(3):386-389.
[8]黄明伟,孔来法,张德意,等.血管介入栓塞在血流动力学不稳定骨盆骨折急救中的应用[J].中华创伤杂志,2016,32(3):244-248.
[9]CHOI W,RHEE H,CHUNG E.Lower urinary tract imaging in pelvic fracture:an 11-year review of genitourinary complications and clinical outcomes[J].ANZ J Surg,2017,87(4):257-261.
[10]侯志勇,尚帅.不稳定骨盆骨折急诊救治中的争议问题[J].中华创伤杂志,2017,33(10):865-867.
[11]杨洪昌,陈仲,陈戈,等.合并开放性骨盆骨折严重多发伤的急诊处置[J].中华创伤杂志,2016,32(2):158-160.