Wu Jun-song, Yi Jian-hua, Sheng Lei, Shi Xiao-yan, Yang Jian-xin, Huang Zong-jian, Gan Jian-xin
Trauma Center of Emergency, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China.
Zhonghua Yi Xue Za Zhi. 2006 Mar 21;86(11):753-8.
To investigate risk factors affecting the survival rate in serious multiple traumatic patients associated with acute lung injure (ALI)/acute respiratory distress syndrome (ARDS).
The clinical data of 76 serious multiple trauma patients associated with ALI and 95 cases in ARDS, totally 171 patients associated with ALI/ARDS, were retrospectively studied, and stepwise logistic regression analysis was used to analyze 20 possible risk factors affecting survival rate.
The risk factors affecting survival rate in the ALI group: included smoking (B = -5.235, OR = 0.005, P = 0.001), sepsis secondary to trauma (B = -2.753, OR = 0.064, P = 0.031), and gastrointestinal hemorrhage (B = -2.876, OR = 0.056, P = 0.033). The risk factors affecting survival rate in the ARDS group included the time of induction factor persisting to attacking (B = 3.524, OR = 33.933, P = 0.008), sepsis secondary to trauma (B = -5.183, OR = 0.006, P = 0.004); renal insufficiency(B = -4.745, OR = 0.009, P = 0.009), and gastrointestinal hemorrhage (B = -6.335, OR = 0.002, P = 0.007).
Different from the results of study of traditional risk factors affecting survival rate in ALI/ARDS, this study reveals that smoking may be an independent risk factor; the earlier ALI/ARDS appears, the lower the predictable survival rate in condition of serious multiple trauma; MODS is easily induced in the course of complicating renal insufficiency during the time of lung injury; sepsis and gastrointestinal hemorrhage are still the infective factors or infection inducing factors affecting the survival rate after trauma; and the primary disease causing infection must be treated actively.
探讨影响伴有急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)的严重多发伤患者生存率的危险因素。
回顾性分析76例伴有ALI的严重多发伤患者和95例ARDS患者(共171例伴有ALI/ARDS的患者)的临床资料,采用逐步逻辑回归分析20个可能影响生存率的危险因素。
影响ALI组生存率的危险因素包括:吸烟(B=-5.235,OR=0.005,P=0.001)、创伤继发脓毒症(B=-2.753,OR=0.064,P=0.031)和消化道出血(B=-2.876,OR=0.056,P=0.033)。影响ARDS组生存率的危险因素包括诱发因素持续至发病的时间(B=3.524,OR=33.933,P=0.008)、创伤继发脓毒症(B=-5.183,OR=0.006,P=0.004)、肾功能不全(B=-4.745,OR=0.009,P=0.009)和消化道出血(B=-6.335,OR=0.002,P=0.007)。
与传统研究影响ALI/ARDS生存率的危险因素结果不同,本研究显示吸烟可能是独立危险因素;ALI/ARDS出现越早,严重多发伤情况下的预计生存率越低;肺损伤时肾功能不全过程中易诱发多器官功能障碍综合征(MODS);脓毒症和消化道出血仍是影响创伤后生存率的感染因素或感染诱发因素;必须积极治疗引起感染的原发疾病。