成人创伤失血早期死亡的预后预测因素：马来西亚一家创伤中心的经验
Prognostic predictors of early mortality from exsanguination in adult trauma: a Malaysian trauma center experience.
作者信息
Huei Tan Jih, Mohamad Yuzaidi, Lip Henry Tan Chor, Md Noh Norazlin, Imran Alwi Rizal
机构信息
Department of General Surgery, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia.
Pusat Perubatan Universiti Kebangsaan Malaysia, Cheras, Malaysia.
出版信息
Trauma Surg Acute Care Open. 2017 May 31;2(1):e000070. doi: 10.1136/tsaco-2016-000070. eCollection 2017.
BACKGROUND
Trauma mortality due to exsanguination is the second most common cause of death. The objective of this study is to investigate the predictors for early death from exsanguination.
METHODS
A prognostic study was done to identify predictors of early mortality due to exsanguination. Data were extracted from our Trauma Surgery Registry database of Sultanah Aminah Hospital, Johor Bahru, Malaysia. All patients who were treated from May 1, 2011 to April 31, 2014 by the trauma team were included. Adult trauma patients included from the Trauma Surgery Registry were divided into two groups for analysis: early death from exsanguination and death from non-exsanguination/survivors. Univariate and multivariate analysis was performed to look for significant predictors of death from exsanguination. Variables analyzed were demography, mechanism of injury, organ injury scale, physiological parameters (systolic blood pressure (SBP), respiratory rate, heart rate, temperature), Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), New Injury Severity Score (NISS), Trauma and Injury Severity Score (TRISS) and cause of death.
RESULTS
A total of 2208 patients with an average age of 36 (±16) years were included. Blunt trauma was the majority with 90.5%, followed by penetrating injuries (9.2%). The overall mortality is 239 out of 2208 (10.8%). Seventy-eight patients (32.6%) died due to central nervous system injury, 69 due to sepsis (28.9%) and 58 due to exsanguination (24.3%). After multivariate analysis, age (OR 1.026 (1.009 to 1.044), p=0.002), SBP (OR 0.985 (0.975 to 0.995), p=0.003) and temperature (OR 0.203 (0.076 to 0.543), p=0.001) were found to be the significant physiological parameters. Intra-abdominal injury and NISS were significant anatomic mortality predictors from exsanguination (p<0.001). Patients with intra-abdominal injury had four times higher risk of mortality from exsanguination (OR 3.948 (2.331 to 6.686), p<0.001).
DISCUSSION
In a Malaysian trauma center, age, SBP, core body temperature, intra-abdominal injury and NISS were significant predictors of early death from exsanguination.
LEVEL OF EVIDENCE
II.
背景
因失血导致的创伤性死亡是第二大常见死因。本研究的目的是调查失血早期死亡的预测因素。
方法
进行了一项预后研究以确定因失血导致早期死亡的预测因素。数据取自马来西亚新山苏丹娜阿米娜医院的创伤外科登记数据库。纳入了2011年5月1日至2014年4月31日期间由创伤团队治疗的所有患者。从创伤外科登记中纳入的成年创伤患者分为两组进行分析：失血早期死亡组和非失血/存活组。进行单因素和多因素分析以寻找失血死亡的显著预测因素。分析的变量包括人口统计学、损伤机制、器官损伤量表、生理参数（收缩压（SBP）、呼吸频率、心率、体温）、格拉斯哥昏迷量表（GCS）、修订创伤评分（RTS）、新损伤严重度评分（NISS）、创伤和损伤严重度评分（TRISS）以及死因。
结果
共纳入2208例平均年龄为36（±16）岁的患者。钝性创伤占大多数，为90.5%，其次是穿透伤（9.2%）。2208例患者中总死亡率为239例（10.8%）。78例患者（3个2.6%）死于中枢神经系统损伤，69例死于败血症（28.9%），58例死于失血（24.3%）。多因素分析后，年龄（比值比[OR]1.026[1.009至1.044]，p = 0.002）、SBP（OR 0.985[0.975至0.995]，p = 0.003）和体温（OR 0.203[0.076至0.543]，p = 0.001）被发现是显著的生理参数。腹腔内损伤和NISS是失血导致解剖学死亡的显著预测因素（p<0.001）。腹腔内损伤患者因失血死亡的风险高四倍（OR 3.948[2.331至6.686]，p<0.001）。
讨论
在马来西亚的一个创伤中心，年龄、SBP、核心体温、腹腔内损伤和NISS是失血早期死亡的显著预测因素。
证据级别
II级。
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