文章摘要

老年多发伤患者短期院内死亡的危险因素

作者: 1梁亚鹏, 1尹其翔, 1周峰, 1苗振军, 1蔡华忠, 1贾珏, 2徐美玲
1 江苏大学附属医院急诊科，江苏 镇江 212001
2 镇江市京口区健康路社区卫生服务中心全科，江苏 镇江 212001
通讯: 梁亚鹏 Email: liangyapeng0371@aliyun.com
DOI: 10.3978/j.issn.2095-6959.2022.07.027
基金: 国家自然科学基金(81500351)；镇江市重点研发计划-社会发展项目(SH2020067)。

摘要

目的：通过回顾分析老年多发伤患者的临床资料，探讨影响老年多发伤患者院内短期死亡的危险因素。方法：回顾性分析2010年1月至2020年12月江苏大学附属医院收治的126例老年多发伤患者的临床资料，通过单因素分析和多因素logistic回归分析探讨影响老年多发伤患者短期(4周内)死亡的危险因素。结果：根据患者是否在入院4周内死亡将126例老年多发伤患者分为存活组(n=102)与死亡组(n=24)。单因素分析显示主要损伤部位、损伤严重度评分(Injury Severity Score，ISS)、急性生理与慢性健康状况(Acute Physiology and Chronic Health Evaluation III，APACHE III)评分、动脉血乳酸水平、是否急诊手术及合并脓毒症在两组间比较，差异有统计学意义(P<0.05)，而性别、年龄、致伤原因、损伤部位数目、入院前时间和是否输血在两组间比较，差异无统计学意义(P>0.05)。多因素logistic回归分析提示ISS评分、主要损伤部位、动脉血乳酸水平和APACHE III评分是影响老年多发伤患者短期(4周内)死亡的独立危险因素(P<0.05)。结论：影响老年多发伤患者短期(4周内)死亡的独立危险因素为ISS评分、主要损伤部位、动脉血乳酸水平和APACHE III评分。在老年多发伤患者的救治过程中，需高度重视整体损伤严重程度的评估和主要损伤部位的规范治疗，同时积极有效地进行液体复苏，改善微循环和维持内环境稳定，可能会更好地改善老年多发伤患者的预后。
关键词： 老年；多发伤；短期；院内死亡；危险因素

Risk factors of short-term in-hospital death in elderly patients with multiple injuries

Authors: 1LIANG Yapeng, 1YIN Qixiang, 1ZHOU Feng, 1MIAO Zhenjun, 1CAI Huazhong, 1JIA Jue, 2XU Meiling
1 Department of Emergency, Affiliated Hospital of Jiangsu University, Zhenjiang Jiangsu 212001, China
2 Department of General, Jiankang Road Community Health Service Center, Jingkou District, Zhenjiang Jiangsu 212001, China

CorrespondingAuthor: LIANG Yapeng Email: liangyapeng0371@aliyun.com

DOI: 10.3978/j.issn.2095-6959.2022.07.027

Foundation: This work was supported by the National Natural Science Foundation (81500351) and Zhenjiang Key Research and Development Program - Social Development Project (SH2020067), China.

Abstract

Objective: To investigate the clinical data retrospectively and analyse the risk factors of short-term in-hospital death in elderly patients with multiple injuries. Methods: The clinical data of 126 elderly patients with multiple injuries admitted to our hospital from January 2010 to December 2020 were retrospectively analyzed. The risk factors of short-term (within 4 weeks) death in elderly patients with multiple injuries were determined by univariate and multivariate logistic regression analysis. Results: According to whether the patient died after admission within 4 weeks, the 126 elderly patients with multiple injuries were divided into a survival group (n=102) and a death group (n=24). Univariate analysis showed the significant difference (P<0.05) between the 2 groups in major injury site, Injury Severity Score (ISS), Acute Physiology and Chronic Health Evaluation III (APACHE III) score, arterial blood lactate level, whether emergency surgery was performed and sepsis was complicated. However, there was no significant difference (P>0.05) between the 2 groups in sex, age, cause of injury, number of injury sites, time before admission and whether with blood transfusion. Multivariate logistic regression analysis suggested that ISS score, major injury site, arterial blood lactate level and APACHE III score were independent risk factors for short-term (within 4 weeks) death in elderly patients with multiple injuries (P<0.05). Conclusion: The independent risk factors for short-term (within 4 weeks) death in elderly patients with multiple injuries were ISS score, major injury site, arterial blood lactate level and APACHE III score. In the treatment of elderly patients with multiple injuries, we should attach great importance to the evaluation of the severity of the overall injury and the standardized treatment of the major injury site. At the same time, active and effective fluid resuscitation, improvement of microcirculation and maintenance of internal environment stability may better improve the prognosis of elderly patients with multiple injuries.

Keywords： elderly; multiple injuries; short-term; in-hospital death; risk factors

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