多发伤早期心肌损害的高危因素分析

目的研究多发伤早期心肌损害的主要危险因素。方法病例均来源于2000年8月至2003年12月收治入院的多发伤患者231例，以心肌损害为因变量，与其相关的20项因素为自变量进行Logistic回归分析，以确定心肌损害的危险因素?结果急性生理学与既往健康状况(APACHEⅡ)≥10、损害严重度评分(ISS)≥25、合并胸伤、胸部简明损伤定级(AIS)≥3、休克指数≥2、低氧血症时间≥0．5h是多发伤早期心肌损害的危险因素，胸部创伤因素与全身损伤危险因素共同存在时，心肌损害的发病危险性(OR)将明显增加．结论对具有高危因素的患者应警惕早期心肌损害的发生，多发伤患者胸部和全身损伤因素共同作用增加早期心肌损害的危险性。

Analysis of high risk factors related to early-onset myocardial damage in multiple trauma patients

Objective To evaluate potential clinical risk factors for the development of early-onset myocardial damage following multiple trauma (MT), and to determine whether early-onset myocardial damage was caused by the combined effects of thoracic and systemic injury factors in MT patients.Methods A total of 231 patients with MT over the last 3 years were retrospectively reviewed. With myocardial damage being a dependent variable and other twenty factors being independent variables, univariate and multivariate logistic regressions were applied to investigate the risk factors for early-onset myocardial damage and to identify the association of thoracic and systemic risk factors with early-onset myocardial damage.Results Multivariable logistic regressions showed that acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ ) score ≥10, injury severity score (ISS) ≥ 25, shock index ≥ 2,coexisting chest trauma, abbreviated injury scale (AIS) of chest≥3, and hypoxia time ≥ 0.5 h were risk factors. The risk of earlyonset myocardial damage following MT obviously increased when thoracic and systemic injury risk factors were coexisting.Conclusion Our results indicated that thoracic injury combined with systemic injury increased the overall risk of early-onset myocardial damage following MT. Prospective validation of these findings in other clinical settings is warranted.