Albaugh G, Kann B, Puc M M, Vemulapalli P, Marra S, Ross S
Department of Surgery, Cooper Hospital/University Medical Center, Camden, New Jersey, USA.
Am Surg. 2000 Oct;66(10):978-81.
Severe chest trauma does not independently predict poor outcome in elderly patients. We chose a specific injury, flail chest, to determine whether age factored into outcome of these patients. A retrospective chart review of all trauma admissions to our Level I trauma center between January 1994 and January 1998 sustaining flail chest was undertaken. Sixty-eight patients were identified, but ten patients were excluded because of death on arrival. Fifty-eight patients were included in the study and separated into groups. The first group comprised those under the age of 55 (n = 32) and the second comprised those over age 55 (n = 26). Parameters evaluated were age, Injury Severity Score (ISS), neurologic injury, the need for mechanical ventilation, need for tracheostomy, length of stay, and death. Statistical analysis was performed with Wilcoxon t test, chi2, and logistic regression where appropriate. A 95 per cent confidence interval was sought as determinant of significance. Of the 58 surviving patients analyzed there was no significant difference between the groups regarding ISS, length of stay, days on the ventilator, head injury, tracheostomy, or development of pneumonia or adult respiratory distress syndrome. The likelihood of death was shown to increase by 132 per cent for every 10 years starting at the second decade and continuing to the eighth decade of life. The likelihood of death also increased by 30 per cent for each unit increase in ISS. The likelihood of death decreased by 23 per cent for every day survived in the hospital. Blunt chest trauma directly impacts respiratory mechanics. Elderly patients are more likely to have comorbid conditions and less likely to tolerate traumatic respiratory compromise. Age (and its effects on the body) is the strongest predictor of outcome with flail chest and is associated with an increased mortality (P < or = 0.05).
严重胸部创伤并不能独立预测老年患者的不良预后。我们选择了一种特定损伤——连枷胸，以确定年龄是否会影响这些患者的预后。我们对1994年1月至1998年1月期间入住我院一级创伤中心且患有连枷胸的所有创伤患者进行了回顾性病历审查。共识别出68例患者，但10例患者因入院时死亡而被排除。58例患者纳入研究并分组。第一组包括55岁以下的患者（n = 32），第二组包括55岁以上的患者（n = 26）。评估的参数包括年龄、损伤严重度评分（ISS）、神经损伤、机械通气需求、气管切开需求、住院时间和死亡情况。在适当情况下，采用Wilcoxon t检验、卡方检验和逻辑回归进行统计分析。以95%置信区间作为显著性的决定因素。在分析的58例存活患者中，两组在ISS、住院时间、呼吸机使用天数、头部损伤、气管切开、肺炎或成人呼吸窘迫综合征的发生方面无显著差异。从第二个十年开始到第八个十年，每10岁死亡可能性增加132%。ISS每增加一个单位，死亡可能性也增加30%。在医院存活的每一天，死亡可能性降低23%。钝性胸部创伤直接影响呼吸力学。老年患者更可能患有合并症，且更难以耐受创伤性呼吸功能不全。年龄（及其对身体的影响）是连枷胸预后的最强预测因素，且与死亡率增加相关（P≤0.05）。
