Rappold Joseph F, Coimbra Raul, Hoyt David B, Potenza Bruce M, Fortlage Dale, Holbrook Troy, Minard Gayle
Department of Surgery, Division of Trauma, Critical Care, and Burns, University of California San Diego, 92103, USA.
J Trauma. 2002 Sep;53(3):436-41; discussion 441. doi: 10.1097/00005373-200209000-00007.
The protective effect of gender on posttraumatic mortality or acute complications (acute respiratory distress syndrome [ARDS], pneumonia, and sepsis) is unclear. To assess potential effects, we performed a retrospective case-controlled study, matching patients for injury factors including overall severity (Injury Severity Sscore), the presence of shock (systolic blood pressure [SBP] < 90 mm Hg) at admission, and the presence of closed head injury (CHI).
All female patients admitted over a 61/2-year period were reviewed and divided into four groups: group 1, SBP > 90, no CHI; group 2, SBP < 90, no CHI; group 3, SBP > 90, with CHI; and group 4, SBP < 90, with CHI. Each cohort was matched one to one with an equivalent male counterpart. Cohorts were compared for mortality or the development of ARDS, pneumonia, and systemic sepsis using standard definitions.
Overall, 1,229 female patients were identified for study. The average Injury Severity Score was 16.3 and overall mortality was 2.7%. Analysis of the groups described previously demonstrated no statistically significant difference in the development of ARDS, pneumonia, systemic sepsis, or overall mortality between male and female patients including patients presenting with shock, CHI, or both.
We conclude that female gender offers no protection from the development of ARDS, pneumonia, sepsis, or decreased mortality after blunt trauma.
性别对创伤后死亡率或急性并发症(急性呼吸窘迫综合征[ARDS]、肺炎和脓毒症)的保护作用尚不清楚。为评估潜在影响,我们进行了一项回顾性病例对照研究,根据损伤因素对患者进行匹配,这些因素包括总体严重程度(损伤严重度评分)、入院时休克(收缩压[SBP]<90mmHg)的存在情况以及闭合性颅脑损伤(CHI)的存在情况。
对6年半期间收治的所有女性患者进行回顾,并分为四组:第1组,SBP>90,无CHI;第2组,SBP<90,无CHI;第3组,SBP>90,有CHI;第4组,SBP<90,有CHI。每个队列与一名同等情况的男性患者进行一对一匹配。使用标准定义比较各队列的死亡率或ARDS、肺炎和全身性脓毒症的发生情况。
总体而言,共确定1229名女性患者进行研究。平均损伤严重度评分为16.3,总体死亡率为2.7%。对上述组别的分析表明,男性和女性患者(包括伴有休克、CHI或两者皆有的患者)在ARDS、肺炎、全身性脓毒症的发生或总体死亡率方面无统计学显著差异。
我们得出结论,女性在钝性创伤后对ARDS、肺炎、脓毒症的发生或死亡率降低并无保护作用。