严重交通伤死亡危险因素与评价

目的探讨影响严重交通伤患者死亡的高危因素及对其预后的影响。方法分析246例严重交通伤死亡患者,男166例,女80例;年龄（48．71±17．12）岁（18～75岁）的相关临床资料。结果重型颅脑损伤和失血所致死亡者分别为150例（60．98％）和46例（18．70％）,重型颅脑外伤并失血性休克10例（占4．07％）,器官功能衰竭死亡者40例（16．26％）。全组生存概率为0．35±0．22;可防止的死亡率（PDR）为44．72％;非预期死亡30例。NP组（136例）的ISS显著高于PP组（107例）,PP组的ISS又显著高于DP组（3例）（均P〈0．01）。NP组的RTS显著低于PP组,PP组的RTS又显著低于DP组（均P〈0．01）。2005年1月～2006年12月,受伤后至确定性治疗前时间为（136．38-36．09）分（第一组）,病死率为30．36％;2007年1月～2008年11月,受伤后至确定性治疗前时间缩短至（101．83±17．74）分（第二组）,病死率23．15％。第二组病死率显著低于第一组（P〈O．05）。不可能防止的死亡（NP）组（n=136）的修正创伤评分（RTS）显著低于有可能防止的死亡（PP组）（n=107）,PP组的RTS又显著低于可防止的死亡fDP）组（n=3）（均P〈0．01）NP组的损伤严重程度评分（ISS）显著高于PP组,而PP组的ISS又显著高于DP组。结论重型颅脑损伤、失血（早期）和器官衰竭（后期）是伤后主要死因。

Risk factors for the death in serious traffic trauma patients

Objective To investigate the risk factors for death in serious traffic trauma patients. Methods The clinical data of 246 patients with serious traffic trauma Jan 2005-Nov 2008 were reviewed. Results 150 of the 246 patients （60.98%） died of heavy brain injury and 46 （18.70%） died of hemorrhagic shock, 10 （4.07%） died of both heavy brain injury and hemorrhagic shock. 40 deaths （16.26 %） were due to organ failure. The survival probability （Ps） of these patients was （0.35±0.22）. preventable death rate （PDR） was 44.72%. The case number of unexpected death was 30. The mortality of the patients who were treated during the period from January 2005 to December 2006 with the pre-definitive treatment time of （136.38±36.09） min was 30.36%, significantly lower than that of the patients who were treated during the period from January 2007 to November 2008 with the pre-definitive treatment time of （101.83 ± 17.74）min （23.15%, P〈0.05）. The revised trauma score （RTS） of the non-preventable （NP） group （n=136） was significantly lower than that of the potentially preventable （PP） group （n=107）, and that of the PP group was significantly lower than thast of the preventable death （DP） group （n=7） （both P〈0.01）. The injury severity score （ISS） of the NP group was significantly higher than that of the PP group , and that of the PP group was significantly higher than that of the DP group （both P〈0,01）. Conclusion The major causes of trauma death include heavy brain injury hemorrhagic shock （early sage）, and organ failure （later stage）.