车祸所致880例四肢开放性损伤并发早期感染的危险性因素分析

doi:10.6040/j.issn.1671-7554.0.2020.1275

摘要/Abstract

摘要： 目的分析与车祸所致四肢开放伤口早期感染有关的危险因素,从而为临床预防和诊治提供依据。方法选取2017年5月至2020年5月收治的四肢开放性损伤患者880例,其中男629例,女251例,19~80岁,平均(43.53±9.78)岁。根据损伤严重程度分为截肢组(n=19例)、无截肢的开放性骨折组(n=266例)、无骨折/无截肢的开放性软组织损伤组(n=595例)。记录各组患者人员特征、受伤情况、住院相关指标和感染的分布情况,建立Logistic逻辑回归模型,确定与感染相关的危险因素。结果截肢组7例(36.84%)发生感染,开放性骨折组26例(9.77%),开放性软组织损伤组15例(2.52%)。截肢组首次记录的休克指数最高(中位数为1.03),且ICU住院率最高(26.32%)。Logistic回归分析结果显示,截肢组(OR=17.684,95%CI:6.262~49.490)和开放性骨折组发生感染(OR=2.733,95%CI:1.453~5.142);伤后24 h内输血(≥8单位:OR=25.852,95%CI:8.448~77.469;4~8单位:OR=17.741,95%CI:5.785~54.409)和大于2个损伤部位(OR=39.731,95%CI:18.048~87.467)与感染风险独立相关。结论创伤评分标准可应用于临床预测评估四肢开放伤早期感染的风险程度;截肢、伤后24 h内输血和多损伤部位(大于2个)是其感染的危险因素。

关键词: 四肢创伤, 交通事故, 急诊科, 感染, 危险因素

Abstract: Objective To analyze the risk factors related to early infections of open extremity injuries caused by traffic accidents so as to provide reference for clinical diagnosis, treatment and prevention. Methods A total of 880 patients with open extremity injuries treated during May 2017 and May 2020 were enrolled in this retrospective study, including 629 males and 251 females, median age 43.53±9.78 years. The patients were divided into 3 groups: amputation group(n=19), open fracture group(n=266)and open soft tissue injury group(n=595). Clinical data, including individual characteristics, injuries, hospitality-related indicators and infections, were collected, a Logistic regression model was established, and infection-related risk factors were determined. Results Infections were observed in 7 patients(36.84%)in the amputation group, 26 patients(9.77%)in the open fracture group, and 15 patients(2.25%)in the open soft tissue injury group. The amputation group had the highest first-recorded shock index(median: 1.03)and the highest ICU hospitalization rate(26.32%). Logistic regression analysis showed that infections in the amputation group(OR=17.684, 95%CI: 6.262-49.490)and open fracture group(OR=2.733, 95%CI: 1.453-5.142), blood transfusion within 24 h after injury(≥8 units: OR=25.852, 95%CI: 8.448-77.469; 4-8 units: OR=17.741, 95%CI: 5.785-54.409)and≥2 injury sites(OR=39.731, 95%CI: 18.048-87.467)were independently associated with risks of infections. Conclusion Abbreviated injury scale can be used to predict and evaluate the risks of early infections in open extremity injuries. Amputation, blood transfusion within 24 hours after injury, and multiple injury sites(>2)are risk factors of infections.

Key words: Extremity injury, Traffic accident, Emergency Department, Infection, Risk factor

中图分类号:

R641

孙胜房,马会力,贾竹亭,李民涛. 车祸所致880例四肢开放性损伤并发早期感染的危险性因素分析[J]. 山东大学学报 (医学版), 2021, 59(1): 72-77.

SUN Shengfang, MA Huili, JIA Zhuting, LI Mintao. Risk factors analysis of 880 cases of open extremity injuries caused by traffic accidents complicated with early infections[J]. Journal of Shandong University (Health Sciences), 2021, 59(1): 72-77.

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