严重钝性创伤患者腹腔内损伤器官与腹腔间隔室综合征的关系：一项使用日本全国创伤登记处的倾向评分匹配研究。
Association between intra-abdominal injured organs and abdominal compartment syndrome in patients with severe blunt trauma: A propensity score matched study using nationwide trauma registry in Japan.
机构信息
Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan.
Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan.
出版信息
PLoS One. 2023 May 23;18(5):e0286124. doi: 10.1371/journal.pone.0286124. eCollection 2023.
INTRODUCTION
Abdominal compartment syndrome (ACS) after blunt abdominal trauma is a rare complication that requires early recognition and subsequent surgical intervention for optimal outcome. We aimed to investigate how differences in injured abdominal organs affect ACS development in patients with severe blunt abdominal trauma.
METHODS
This nested case-control study used a nationwide registry of trauma patients, namely, the Japan Trauma Data Bank (JTDB), and only included patients aged ≥ 18 years with blunt severe abdominal trauma, defined as an AIS score of abdomen ≥ 3, sustained between 2004 and 2017. Patients without ACS were used as control subjects and identified using propensity score (PS) matching. Characteristics and outcomes between patients with and without ACS were compared and logistic regression was used to identify specific risk factors for ACS.
RESULTS
Among 294,274 patients in the JTDB, 11,220 were eligible for inclusion before PS matching, and 150 (1.3%) developed ACS after trauma. PS matching led to the inclusion of 131 and 655 patients with and without ACS, respectively. Compared to controls, patients with ACS had higher number of injured organs in the abdomen and displayed a greater frequency of vascular and pancreatic injuries, need for blood transfusion, and disseminated intravascular coagulopathy, a complication of ACS. In-hospital mortality was higher in patients with ACS than those without ACS (51.1% vs. 26.0%, p < 0.01). Logistic regression analysis revealed that a higher number of injured organs in the abdomen [odds ratio (OR) (95% confidence interval [CI]): 1.76 (1.23-2.53)] and pancreatic injury [OR (95% CI): 1.53 (1.03-2.27)] were independently associated with ACS.
CONCLUSIONS
Greater number of injured organs in abdomen and pancreatic injury are independent risk factors for the development of ACS.
简介
钝性腹部创伤后发生的腹腔间隔室综合征（ACS）是一种罕见的并发症，需要早期识别并随后进行手术干预以获得最佳结果。我们旨在研究受伤的腹部器官的差异如何影响严重钝性腹部创伤患者 ACS 的发展。
方法
本嵌套病例对照研究使用了一个全国性的创伤患者登记处，即日本创伤数据库（JTDB），并仅纳入 2004 年至 2017 年期间年龄≥18 岁、腹部损伤严重程度评分（AIS 评分）≥3 分的钝性严重腹部创伤患者。无 ACS 的患者被用作对照，并通过倾向评分（PS）匹配进行识别。比较 ACS 患者与无 ACS 患者的特征和结局，并使用逻辑回归分析确定 ACS 的特定危险因素。
结果
在 JTDB 中的 294274 名患者中，有 11220 名在 PS 匹配前符合纳入标准，其中 150 名（1.3%）在创伤后发生 ACS。PS 匹配后纳入了 131 名 ACS 患者和 655 名无 ACS 患者。与对照组相比，ACS 患者腹部受伤器官的数量更多，并且血管和胰腺损伤、输血需求和弥漫性血管内凝血（ACS 的并发症）的发生率更高。ACS 患者的住院死亡率高于无 ACS 患者（51.1%比 26.0%，p<0.01）。逻辑回归分析显示，腹部受伤器官数量更多（优势比[OR]（95%置信区间[CI]）：1.76（1.23-2.53））和胰腺损伤（OR[95%CI]：1.53（1.03-2.27））是 ACS 的独立危险因素。
结论
腹部受伤器官数量更多和胰腺损伤是 ACS 发生的独立危险因素。
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