Lorelli D R, Kralovich K A, Seguin C
Department of General Surgery and Trauma, Henry Ford Hospital, Detroit, Michigan, USA.
Am Surg. 2001 Jul;67(7):693-6.
End-stage renal disease and associated dialysis procedures alter homeostatic mechanisms and adversely affect the respiratory, cardiac, and central nervous systems. Currently outcomes research in acutely injured trauma patients utilizes Trauma and Injury Severity Score methodology with the Injury Severity Score and Revised Trauma Score, which do not account for comorbidities. Literature has yet to emerge that analyzes the effects of end-stage renal disease on acutely injured trauma patients. A retrospective review at an urban Level I trauma center was performed of all end-stage renal disease patients' medical records who were admitted for acute traumatic injury from 1994 through 1997. The charts were abstracted for age, sex, race, method of dialysis, specific injury, need for operation, etiology of trauma, length of stay, disposition from hospital, morbidity, and mortality. The Injury Severity Score; probability of survival; and W, M, and Z statistics were then calculated. The data collected were then compared with the overall data for the trauma center including patients with and those without end-stage renal disease during this time period. Mortality for patients with end-stage renal disease after suffering an acute traumatic injury is 2.45 that of the general population. Increased mortality was most prevalent in operative patients and those with Injury Severity Score >15. The average length of stay in the hospital was 55.3 per cent longer for patients with end-stage renal disease. Pre-existing end-stage renal disease negatively impacts survival after traumatic injury. A prospective multicentered study comparing renal patients with nonrenal patients is warranted. This would confirm the need for databases to account for the increased morbidity and mortality associated with end-stage renal disease when calculating probability of survival values for acutely injured trauma patients. Similarly future studies analyzing the affects of other comorbidities such as diabetes, chronic obstructive pulmonary disease, and hypertension on acutely injured trauma patients would help develop a more accurate method of predicting outcomes.
终末期肾病及相关透析程序会改变体内稳态机制，并对呼吸、心脏和中枢神经系统产生不利影响。目前，急性创伤患者的结局研究采用创伤和损伤严重程度评分方法，包括损伤严重程度评分和修订创伤评分，但这些方法未考虑合并症情况。尚未有文献分析终末期肾病对急性创伤患者的影响。我们对一家城市一级创伤中心1994年至1997年期间收治的所有因急性创伤入院的终末期肾病患者的病历进行了回顾性研究。提取了病历中的年龄、性别、种族、透析方法、具体损伤情况、手术需求、创伤病因、住院时间、出院情况、发病率和死亡率等信息。然后计算损伤严重程度评分、生存概率以及W、M和Z统计量。接着将收集到的数据与该创伤中心同期包括有和没有终末期肾病患者的总体数据进行比较。急性创伤后终末期肾病患者的死亡率是普通人群的2.45倍。手术患者和损伤严重程度评分>15的患者死亡率增加最为普遍。终末期肾病患者的平均住院时间长55.3%。预先存在的终末期肾病会对创伤后的生存产生负面影响。有必要进行一项前瞻性多中心研究，比较肾病患者和非肾病患者。这将证实需要建立数据库，以便在计算急性创伤患者的生存概率值时考虑与终末期肾病相关的发病率和死亡率增加的情况。同样，未来分析糖尿病、慢性阻塞性肺疾病和高血压等其他合并症对急性创伤患者影响的研究，将有助于开发更准确的结局预测方法。
