闭合性腹部损伤患者死亡危险因素分析

目的探讨影响闭合性腹部损伤(BAT)患者死亡的危险因素,为进一步提高BAT存活率提供科学依据。方法对郑州大学第一附属医院急诊科2011年1月至2018年12月收治的731例BAT患者的临床资料进行回顾性分析,根据纳入、排除标准共680例纳入研究,排除51例。结果将纳入研究的680例BAT患者分为存活组(n=650)和死亡组(n=30),其中受伤至就诊时间、合并失血性休克、合并颅脑损伤、合并多发伤、入院收缩压<60 mmHg(1 mmHg=0.133 k Pa)、入院24 h内红细胞比容(Hct)<40%及动脉血碱剩余(BE)<-6 mmol/L两组间比较差异有统计学意义(P<0.05);而性别、年龄、致伤原因及合并感染两组间比较差异无统计学意义(P>0.05);多因素logistic回归分析显示,受伤至就诊时间、合并失血性休克、合并多发伤、入院24 h内Hct及BE是影响BAT患者预后的独立危险因素(P<0.05)。结论受伤至就诊时间、入院24 h内Hct<40%、BE<-6 mmol/L、合并失血性休克及合并多发伤是影响BAT患者死亡的独立危险因素,可以作为评估BAT患者预后的指标。

Analysis of death risk factors in patients with blunt abdominal trauma

Objective To explore the risk factors that affect the death of patients with blunt abdominal trauma(BAT),and provide evidence for further improving the survival rate of BAT. Methods The clinical data of 731 BAT patients admitted to the emergency department of the First Affiliated Hospital of Zhengzhou University from January 2011 to December 2018 were retrospectively analyzed. According to the inclusion and exclusion criteria,a total of 680 cases were included in the study,and 51 cases were excluded. Results The 680 BAT patients included in the study were divided into the survival group(n=650 cases)and the death group(n=30 cases). Among them,the time from injury to consultation,being combined with hemorrhagic shock,being combined with head injury,being combined with multiple injuries,and SBP<60 mmHg(1 mmHg=0.133 kPa)at admission,hematocrit(Hct)within 24 hours of admission<40% and arterial base excess(BE)<-6 mmol/L,between the two groups had statistically significant difference(P<0.05),while there was no significant difference between the two groups in gender,age,cause of injury or co-infection(P>0.05). Multivariate logistic regression analysis showed that the time from injury to treatment,being combined with hemorrhagic shock,being combined with multiple injuries,Hct and arterial base excess within 24 h of admission were independent risk factors affecting the prognosis of BAT patients(P<0.05). Conclusion The time from injury to treatment,Hct within 24 hours of admission<40%,BE<-6 mmol/L,being combined with hemorrhagic shock,and being combined with multiple injuries are independent risk factors that affect the death of BAT patients,and can be used as indicators to evaluate the prognosis of BAT patients.