胸部创伤为主的多发伤并发感染的预测与辅助诊断

目的:筛选出影响以胸部创伤为主的多发伤患者并发感染的危险因素,并探讨伤后第1 d患者血浆中IIL-1β、TNFα、IFN-γ与后期并发感染的关系.方法:选取重庆市急救医疗中心于2006年1月～2008年6月救治的230例以胸部创伤为主的多发伤病例,分为并发感染组91例,非感染组139例.通过定群多因素研究,对32项潜在危险因素的单变量与多变量进行logistic回归分析,并结合实验室检查.结果:(1)并发感染的相对危险度与下列因素有关:多器官功能衰竭评分(MODS评分)、手术次数(≥2次)、胃内容物误吸、脑损伤、胰损伤、肾损伤及胃肠道损伤.(2)感染组血浆IL-1β、TNFα、IFN-γ明显高于非感染组(1501.19±2186.06ps/ml与1127.07±1755.43pg/ml、5251.46±5554.46pg/ml与5101.83±4357.64pg/ml、181.97±276.18pg/ml与34.89±108.42pg/m1)(P＜0.05).结论:胸部创伤为主的多发伤患者MODS评分越高、合并颅脑损伤及腹部创伤越重、昏迷致胃内容物误吸、手术次数越多,并发感染可能性越大;伤后第1天血浆中IL-1β、TNFα及IFN-γ水平的升高幅度可以作为预判患者后期是否并发感染的参考.

Prediction and accesory diagnosis of infection in patients of chest trauma with multiple trauma

Objective: To retrospectively demonstrate risk factors for thoracic injuries with multiple trauma superinduct infection and study the relationship between interleukin and infection. Methods :230 patients having chest trauma with multiple trauma (91 superinduct infection and 139 uninfection) from January 2006 to June 2008 in department of cardiothoracic surgery, Chongqing emergency medical center were analyzed . This was a retrospective cohort study regarding multiple trauma as causes, and 32 items of potential risk factors of impacting mortality were calculated by univariate and multivariate logistic in order to find distinctive items in these patients and laboratory test Results:The odds ratio (OR) and 95% confidence intervals (CI) of infection fate were associated with seven risk factors multiple organs dysfunction syndrome scale, quantities of operation ( ≥2), aspiration of gastric contents, associated head injury, pancreas injury, kidney injury, and gastrointestinal tract injury]. The mean plasma concentration of IL-1β, TNF α , and IFN-γ in the infection group were higher than those in the uninfection group respectively (1501.19 ± 2186.06 pg/ml vs 1127.07 ± 1755.43 pg/ml, 5251.64 ± 5554.46 pg/ml vs 5101.83 ±4357.64 pg/ml, 181.97 ±276.18 pg/ml vs 34.89 ±108.42 pg/ml) (P＜0.05). Conclusion:There were significant relationship between the MODS scale, associated head and abdominal injury, quantities of operation and infection complication in patients having chest trauma with multiple trauma. The plasma concentration of IL-1 β ,TNFα ,and IFN-γ of patients on the first day after injury could be the reference to judge patient' s in the later period.