Vyhnánek František, Očadlík Martin, Drienko Miroslav, Gürlich Robert
Cas Lek Cesk. 2020 Spring;159(1):17-21.
Higher incidence of injury in trauma patients older than 65 years is connected with growing morbidity and mortality, first of all in polytrauma. Incidence of preexisting diseases play a great role in development of postinjury reaction. There are risk factors for genesis of postinjury complications and also mortality of victims. Growing number of polytrauma patients older than 65 years admitted to Trauma Centre Faculty Hospital Královské Vinohrady was reason for evaluation of epidemiological data and their comparison with data regarding to victims younger than 65 years. In retrospective study was evaluated 239 injured patients with polytrauma, admitted in Emergency unit Department of anesthesiology and resuscitation. From overall number was 47 victims older than 65 years (29/61 %). 75 years was an average age in victims older than 65 years. Primary admission to Trauma Centre was in case of 42 (85 %) victims older than 65 years. Between causes of injury were most frequent traffic accidents and falls. Most frequent injury in geriatric patients was craniocerebral injury in 36 patients (76 %) and thoracic trauma in 38 patients (80 %). Skeletal fractures of extremities were found in 21 (44 %) victims. From comparison of APACHE II score in both group of patients (19 in group of younger patients vs. 27,2 in group of older victims) is possible to establish higher incidence of preexisting diseases in patients older than 65 years. Average ISS score evaluated serious of trauma was without statistic significant difference (22 vs. 21). Number of deaths was 42 (22 %) in group of victims younger than 65 years and 22 (47 %) in group of victims older than 65 years. Older victims (over 65 years old) were exposed higher mortality in comparison with younger patients. On the result of treatment participate preexisting diseases besides age. Mechanism of injury and from this resulting type of trauma in older population need new strategy in postinjury care. Performance of primary admission of older victims with polytrauma to Trauma Centre is tend to this strategy.
65岁以上创伤患者的损伤发生率较高，这与发病率和死亡率的增加有关，尤其是在多发伤患者中。既往疾病的发生率在伤后反应的发展中起着重要作用。存在伤后并发症发生及受害者死亡的风险因素。越来越多65岁以上的多发伤患者被收治到克拉洛夫斯基维诺拉迪大学医院创伤中心，这是评估流行病学数据并将其与65岁以下受害者数据进行比较的原因。在一项回顾性研究中，对239例因多发伤而在麻醉与复苏急诊科就诊的受伤患者进行了评估。总共有47名受害者年龄超过65岁（29/61%）。65岁以上受害者的平均年龄为75岁。42名（85%）65岁以上的受害者是首次入住创伤中心。在受伤原因中，最常见的是交通事故和跌倒。老年患者中最常见的损伤是颅脑损伤，有36例（76%），胸部创伤有38例（80%）。21名（44%）受害者存在四肢骨骼骨折。通过比较两组患者的急性生理与慢性健康状况评分系统（APACHE II）评分（年轻患者组为19分，老年受害者组为27.2分），可以确定65岁以上患者中既往疾病的发生率更高。评估创伤严重程度的平均损伤严重度评分（ISS）没有统计学显著差异（22分对21分）。65岁以下受害者组的死亡人数为42例（22%），65岁以上受害者组为22例（47%）。与年轻患者相比，老年受害者（65岁以上）的死亡率更高。除年龄外，既往疾病也会影响治疗结果。老年人群的损伤机制以及由此导致的创伤类型需要新的伤后护理策略。将老年多发伤受害者首次收治到创伤中心的做法倾向于采用这种策略。
