实施损伤控制手术的27例严重多发伤患者的预后因素分析

目的 探讨严重多发伤患者实施损伤控制手术(DCS)的疗效并分析影响其预后的相关因素.方法 1998年5月至2007年2月在合并严重腹部创伤的多发伤患者中接受DCS的患者有27例.记录患者的手术并发症及死亡原因,并比较存活组和死亡组患者的术前一般资料、损伤严重程度评分(ISS)、手术方式、治疗情况及各种围手术期生命体征、器官功能变化情况,采用多因素Logistic回归分析影响患者病死率的相关预后因素.结果 全部患者的手术并发症发生率为37.0%,最常见的手术并发症为腹腔内感染(18.5%);术后总体病死率为44.4%(12例),最常见的死亡原因为多器官功能障碍综合征(MODS)(50.0%);影响DCS术后病死率的因素包括年龄、ISS、术前体温和碱剩余(BE)值、估计失血量、ICU入室体温以及住院时间(P<0.05);其中,年龄增长、术前BE绝对值增加和ICU入室体温降低是预测DCS术后患者病死率的独立预后因素(P<0.05).结论 严重多发伤患者接受DCS后手术并发症和病死率仍较高,年龄增长、术前BE绝对值增加和ICU入室体温降低是术后病死率的独立预后因素.

Predictors of mortality in critically multiple trauma patients after damage control surgery

Objective To investigate the efficiency of dmage control surgery (DCS) and predictors of mortality in critically multiple trauma patients. Methods From May 1998 to February 2007, DCS were carried out in 27 patients with critically multiple trauma. Of the patients 15 cases survived (survival group) and 12 cases died(dead group). The surgical complications, causes of death, demographic, physiologic and medical parameters were collected and compared between the two groups. Multiple logistic regression analysis were performed to identify possible predictors of mortality. Results The incidence of surgical complications was 37.0 percent, and the intra-abdominal infections was the most frequent (18.5%). The overall mortality rate was 44.4 percent. The most common causes of death was multiple organ dysfunction syndrome (50.0%). With respect to predicting mortality, statistically significant differences was found in parameters as age, injury severity score(ISS), initial temperature and base excess(BE), estimated blood loss, initial ICU temperature and length of hospital stay. Older age, increased absolute value of initial BE and lower initial ICU temperature were determined as independent predictors of mortality on multiple logistic regression analysis.