重庆地区不同时期严重胸部创伤流行病学特征及救治结局的回顾性分析

目的探讨重庆地区不同时期严重胸部创伤(severe chest trauma,SCT)的流行病学特征及临床特点。方法对重庆市急救医疗中心1990年1月至2009年12月救治的SCT1 834例(胸部AIS≥3且ISS≥16)进行回顾性分析。按不同时期分为2000年前组(1990年1月至1999年12月)和2000年后组(2000年1月至2009年12月),按结局分为生存组和死亡组。结果 2000年前后比较,钝性伤构成比分别为68.5%和74.7%(P<0.01);交通伤构成比分别为54.37%和58.94%(P=0.069);锐器伤构成比分别为12.21%和15.9%(P<0.05);2000年后院前时间缩短(P<0.01),转院率增高(P<0.05);胸简明损伤定级标准(abbre viated injury injury scale,AIS)、修正创伤评分(revised trauma score,RTS)增高(P<0.01);严重心脏大血管损伤、严重胸腹联合伤及合并严重脑外伤例数、年平均例数明显高于2000年前组(P<0.01)。2000年前严重并发症发生率(314/565,55.58%)比2000年后(673/1 269,53.03%)高,但差异无统计学意义(P=0.338);2000年后肺部感染及创伤性休克治疗效果有显著性提高(P=0.019,P=0.008);死亡率由7.07%降至4.81%(P<0.05);住院天数减少,但差异无统计学意义(P=0.063);首要致死原因为低血容量休克(59.41%);各评分指标在生存组和死亡组间有显著性差异(P<0.01)。结论 2000后SCT的发生率增多,病情更重,但救治水平明显提高。

Epidemiological characteristics and treatment outcome of severe chest trauma in Chongqing during different periods

Objective To analyze the epidemiological characteristics and clinical features of severe chest trauma(SCT) in Chongqing during different periods in order to improve severe chest trauma care outcome.Methods A total of 1 834 cases of severe chest trauma with AIS ≥ 3 and ISS ≥16 in Chongqing Emergency Medical Center from January 1990 to December 2009 were reviewed retrospectively.These patients were divided into 2 groups according to the treatment time(cases treated before 2000 and those after 2000),and were divided into different groups according to their outcome(survival group and death group).Results Before and after 2000,blunt trauma covered 68.5% and 74.7% respectively(P<0.01),traffic injury covered 54.37% and 58.94% respectively(P=0.069),and sharp instrument injury covered 12.21% and 15.9%(P<0.05),with statistical significances(P<0.01,P<0.05).After 2000,the pre-hospital time and transfers ratio had statistical significances(P<0.01,0.05).Before and after 2000,there were statistical significances in thoracic AIS and RTS(P<0.01).The after 2000 group had statistical higher in average numbers of heart and great vessels serious injury,of combined thoraco-abdominal wound and cerebral trauma compared with the group before 2000.The incidence rate of severe complications in the group after 2000 was 55.58%(314/565),higher than that of the group before 2000(673/1 269,53.03%) though without significant difference(P=0.338).The therapeutic effect to pulmonary infection and traumatic shock was significantly improved in the group after 2000 compared with that of the group before 2000(P=0.019,P=0.008),the mortality was decreased from 7.07% to 4.81%(P<0.05),and the hospitalization days was reduce though with no statistical significance(P=0.063).The most important cause of death was hypovolemic shock(59.41%),followed by ARDS/respiratory failure(18.81%),MODS(13.86%),and primary brain trauma(7.92%).There was statistically difference in trauma score of the death group and the survival group(P<0.01).Conclusion After 2000,the incidence of SCT is significantly increased,and becomes more serious,but therapeutic effects of serious complications is greatly improved.