影响腹部创伤患者损害控制手术后生存率 相关因素分析.docVIP

影响腹部创伤患者损害控制手术后生存率 相关因素分析 　 作者：薛绪潮，申晓军，王尧，张旭魁 【摘要】 目的 探讨影响实施损害控制手术（DCS）腹部创伤患者生存率的相关因素。方法 回顾性分析27例实施DCS患者的临床资料，比较存活组和死亡组病人的术前一般情况、ISS、手术方式、治疗情况及各种围手术期生命体征、器官功能变化情况，最后采用多因素Logistic回归分析影响患者生存率的相关预后因素。结果 影响DCS患者术后生存率的因素包括年龄、ISS、术前体温和碱剩余（BE）值、估计失血量、ICU入室体温以及住院时间（P＜0.05）；其中，年龄增长、术前BE绝对值增加和ICU入室体温降低是预测DCS术后患者生存率的独立预后因素（P＜0.05）。结论 DCS有助于提高严重腹部创伤患者术后生存率，年龄增长、术前BE绝对值增加和ICU入室体温降低是影响生存率的独立预后因素。 【关键词】 腹部损伤；损害控制；生存率 Abstract： Objective To investigate the efficacy of dmage control surgery(DCS) and predictors of survival rates in 27 severe abdominal trauma patients.Methods From May 1998 to February 2007,27 patients with severe multiple trauma were managed by DCS.All the patients were divided into two groups: survivors group(15 cases) and death group(12 cases).All of the demographic,physiologic and medical parameters were collected and compared between two groups.Multiple logistic regression analysis was performed to identify possible predictors of survival rates.Results The overall survival rate of all the patients was 55.56%.With respect to predictors of survival rates,statistically significant differences（P＜0.05）were found in several parameters,including age,ISS,initial temperature and base excess(BE),estimated blood loss,initial ICU temperature and hospital days.At last,age increasing,absolute value increasing of initial BE and lower initial ICU temperature were determined as independent predictors of survival rates by multiple logistic regression analysis.Conclusion DCS is helpful to increase survival rates of severe abdominal trauma patients.Age increasing,larger absolute value of initial BE and lower initial ICU temperature could independently predict survival of the patients. Key words：abdominal injury;damage control;survival rates 1993年Rotondo等［1］提出的“损害控制手术”（damage control surgery,DCS）理念已经广泛应用于各类创伤救治过程中，但文献所报道的术后生存率存在较大的差别。我院自1998年5月～2007年2月共对27例严重创伤患者实施DCS，最终存活15例，本文将着重分析影响DCS术后生存率的相关因素。临床资料 1 一般资料 本组男性21例，女性6例；年龄18～65岁，平均31.2岁。自受伤至达到医院时间为0.5～27小时，平均3.4小时。致伤原因：道路交通伤1