佟梦琦,白颖,王姗,周宁
TONG Mengqi,BAI Ying,WANG Shan,ZHOU Ning

• 1:北京积水潭医院重症医学科
• 2:东北伊利诺伊大学数学系

摘要(Abstract)：

目的:探讨影响严重创伤伴骨盆骨折患者临床预后的危险因素。方法:收集55例严重创伤伴骨盆骨折患者的临床资料,比较伤后30 d时死亡患者和存活患者损伤严重程度(ISS)评分及急性生理与慢性健康(APACHEⅡ)评分,采用多因素线性方法分析影响患者总住院时间及ICU住院时间的因素,Logistic回归方法分析治疗后6个月及12个月时影响患者功能恢复情况的因素、治疗后12个月时影响患者工作恢复情况的因素。结果:伤后30 d内死亡患者ISS、APACHEⅡ评分明显高于存活患者(P<0.01),多因素线性回归结果显示,术后感染是ICU住院时间及总住院时间延长的危险因素(β=0.309、0.031,P=0.397、0.004),Logistic回归结果显示,术后感染是患者术后6个月不能独立生活的危险因素(OR=11.954,P=0.002),受伤后休克和高APACHEⅡ是患者术后12个月不能恢复工作的危险因素(OR=5.065、0.745,P=0.047、0.043)。结论:ISS、APACHEⅡ评分及术后感染和受伤后休克是影响严重创伤伴骨盆骨折患者短期及长期预后的危险因素。
Objective: To investigate the risk factors affecting prognosis of patients with pelvic fracture associated with major trauma. Methods: Baseline informations of 55 enrolled patients with pelvic fracture associated with major trauma were collected. The injury severity score( ISS) and the acute physiology and chronic health evaluation( APACHE Ⅱ) of the survival group and the death group were compared in 30 days after injury. The factors of the length of hospital and ICU stay were analyzed by the linear regression method,and the factors affecting the functional recovery and returning to work after treatment were analyzed by logistic regression method. Results: The death group's ISS and APACHE Ⅱ were significantly higher than those of the survival group within 30 days after injury( P <0. 01). The linear regression showed that infection after operation was risk factors affecting the length of hospital and ICU stay( β = 0. 309,0. 031,P = 0. 397,0. 004); Logistic regression showed that infection was also factors affecting independent living ability 6 month after operation( OR = 11. 954,P =0. 002). And shock and high APACHE Ⅱ level were associated with the factors of not returning to work in 12 month after operation( OR = 5. 065,0. 745,P = 0. 047,0. 043). Conclusions: ISS,APACHE Ⅱ,infection and shock after operation are risk factors affecting short and long term prognosis of patients with pelvic fracture associated with major trauma.

关键词(KeyWords)： 骨盆骨折;预后;危险因素;损伤严重程度评分;急性生理与慢性健康评分;严重创伤
pelvic fracture;prognosis;risk factors;injury severity score;acute physiology and chronic health evaluation;major trauma

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 佟梦琦,白颖,王姗,周宁
TONG Mengqi,BAI Ying,WANG Shan,ZHOU Ning

DOI: 10.19367/j.cnki.1000-2707.2017.11.027

参考文献(References)：

• [1]Breuil V,Roux CH,Carle GF.Pelvic fractures:epidemiology,consequences,and medical management[J]Curr Opin in Rheumatol,2016(4):442-447.
• [2]Costantini TW,Coimbra R,Holcomb JB,et al.Current management of hemorrhage from severe pelvic fractures:Results of an american association for the surgery of trauma multi-institutional trial[J].J Trauma Acute Care Surg,2016(5):717-723.
• [3]Sarah M,Mark SP,Xue YJ,et al.Admission for osteoporotic pelvic fractures and predictors of length of hospital stay,mortality and loss of independence[J].Age and Aging,2015(44):258-261.
• [4]施乾坤,董妮珊,陈尚榆,等.Tile C型骨盆骨折患者死亡相关危险因素分析[J].临床麻醉学杂志,2015(12):1208-1210.
• [5]Dodd AC,Bulka C,Jahangir A,et al.Predictors of 30-day mortality following hip/pelvis fractures[J].Orthop Traumatol Surg Res,2016(6):707-710.
• [6]Sharpe JP,Magnotti LJ,Gobbell WC,et al.Impact of early operative pelvic fixation on long-term self-reported outcome following severe pelvic fracture[J].J Trauma Acute Care Surg,2017(3):444-450.
• [7]Gabbe BJ,Hofstee DJ,Esser M,et al.Functional and return to work outcomes following major trauma involving severe pelvic ring fracture[J].ANZ J Surg,2015(10):749-754.
• [8]Williamson OD,Gabbe BJ,Forbes AM,et al.Comparing the responsiveness of functional outcome assessment measures for trauma registries[J].J Trauma,2011(1):63-68.
• [9]Pereira GJC,Damasceno ER,Dinhane DI,et al.Epidemiology of pelvic ring fractures and injuries[J].Rev Bras Ortop,2017(3):260-269.
• [10]杨光,李佳,于沂阳,等.2003年至2012年河北医科大学第三医院成人骨盆骨折的流行病学研究[J].中华创伤骨科杂志,2016(7):607-611.
• [11]Vaidya R,Scott AN,Tonnos F,et al.Patients with pelvic fractures from blunt trauma,What is the cause of mortality and when[J].Am J Surg,2016(3):495-500.
• [12]Dong J,Hao W,Wang B,et al.Management and outcome of pelvic fractures in elderly patients:a retrospective study of 40 cases[J].Chin Med J,2014(5):2802-2807.
• [13]詹祖峰,刘晓霞,姚忠军,等.骨盆骨折患者临床预后及相关死亡原因分析[J].医学临床研究,2015(7):1386-1388.
• [14]Tosounidis H,Sheikh H,Giannoudis PV.Pelvic fractures in paediatric polytrauma patients:classification,concomitant injuries and early mortality[J].Open Orthop J,2015(9):303-312.
• [15]韦功滨,高劲谋,胡平,等.多发伤伴严重骨盆骨折的救治[J].创伤外科杂志,2016(5):265-268.
• [16]杨帆,宋宪舟,胡耑,等.合并骨盆骨折和腹部损伤多发伤患者的临床特点分析[J].创伤外科杂志,2015(1):20-24.
• [17]Arroyo W,Nelson KJ,Belmont PJ,et al.Pelvic trauma:What are the predictors of mortality and cardiac,venous thrombo-embolic and infectious complications following injury[J].Injury,2013(12):1745-1749.
• [18]Orhon R,Eren SH,Karadayi S,et al.Comparison of trauma scores for predicting mortality and morbidity on trauma patients[J].Ulus Travma Acil Cerrahi Derg,2014(4):258-264.
• [19]周代君,邱俊,袁丹凤,等.严重创伤生存概率评估方法与评价[J].伤害医学,2015(1):56-59.
• [20]张莉.重症监护室医院感染目标性监测结果分析及对策[J].中国药物与临床,2016(5):742-743.
• [21]陈中伟,马晓,杨立山.急诊重症监护室严重创伤患者预后的相关因素分析[J].宁夏医科大学学报,2016(7):800-802.
• [22]Maier GS,Kolbow K,Lazovic D,et al.Risk factors for pelvic insufficiency fractures and outcome after conservative therapy[J].Arch Gerontol Geriatr,2016(6):80-85.

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