Michelet Pierre, Couret David, Brégeon Fabienne, Perrin Gilles, D'Journo Xavier-Benoit, Pequignot Véronique, Vig Véronique, Auffray Jean-Pierre
Réanimation des Urgences, Hôpital Sainte Marguerite, Université de la Méditerranée, Marseille, France.
J Trauma. 2010 Feb;68(2):395-400. doi: 10.1097/TA.0b013e3181a601cb.
The development of an early-onset pneumonia (EOP), occurring within the first 72 hours after admission, represents a critical event in severe thoracic trauma population. The aim of this study was to determine risk factors associated with the occurrence of this complication in this specific population.
A retrospective review of a prospective implemented trauma registry was conducted during a 4-year period in a Level I trauma center. Over the study period, 223 severely injured patients were admitted with severe thoracic trauma (Injury Severity Score >16 and Thorax Abbreviated Injury Score >2). Multiple logistic regression analysis was used to determine the independent predictors of EOP based on the clinical characteristics and the initial management both in the field and after admission in the trauma center.
Independent predictors of EOP were the necessity of intubation and mechanical ventilation in the field (adjusted odds ratio [OR]: 11.8; 95% confidence interval [CI]: 4.3-32.7), a history of aspiration (OR: 28.6; 95% CI: 4.0-203.5), the presence of pulmonary contusion (OR: 7.0; 95% CI: 2.0-23.9), and the occurrence of a hemothorax (OR: 3.2; 95% CI: 1.4-7.6).
These results emphasize the influence of prehospital and early factors in the further occurrence of EOP, which allows the development of early and specific clinical management to prevent it.
早发性肺炎（EOP）在入院后72小时内发生，是严重胸部创伤患者的关键事件。本研究旨在确定这一特定人群中与该并发症发生相关的危险因素。
在一家一级创伤中心对前瞻性实施的创伤登记进行了为期4年的回顾性研究。在研究期间，223例严重受伤患者因严重胸部创伤入院（损伤严重度评分>16，胸部简明损伤评分>2）。采用多因素logistic回归分析，根据临床特征以及在现场和创伤中心入院后的初始处理情况，确定EOP的独立预测因素。
EOP的独立预测因素包括现场插管和机械通气的必要性（校正比值比[OR]：11.8；95%置信区间[CI]：4.3 - 32.7）、误吸史（OR：28.6；95% CI：4.0 - 203.5）、肺挫伤的存在（OR：7.0；95% CI：2.0 - 23.9）以及血胸的发生（OR：3.2；95% CI：1.4 - 7.6）。
这些结果强调了院前和早期因素对EOP进一步发生的影响，这有助于制定早期和针对性的临床管理措施以预防EOP。
