Risk factors analysis and treatment strategies for pre-hospital treatment of multiple injuries
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摘要: 目的 分析多发伤院前救治危险分级上升的危险因素, 有针对性地加强救治措施, 以便为院前急救提供指导, 提高多发伤患者的抢救成功率。方法 回顾调查2017年1月-2021年12月期间我院收治的330例多发伤患者流行病学特点及院前救治效果并计算创伤指数(TI), 将院前救治后送达医院时TI值没有上升到高一级危险分级的患者纳入有效组(n=208), TI值上升到高一级危险分级纳入无效组(n=122)。通过单因素筛查和多因素logistic回归分析模型分析危险因素对病情的影响。结果 多发伤主要原因是交通伤(70.3%)和高处坠落伤(22.4%), 多见于男性(74.5%)。患者年龄≥60岁、创伤部位数量≥3处、转运到达时间≥30 min、指氧饱和度 < 94%、休克指数(SI)≥1.5、低体温和TI>16分为多发伤患者危险因素(P < 0.05)。结论 患者年龄≥60岁、创伤部位数量≥3处、转运到达时间≥30 min、指氧饱和度 < 94%、SI≥1.5、低体温和TI>16分的多发伤患者病情进展快、死亡风险高, 应该引起院前急救医生的高度重视, 并有针对性地在有效止血、可靠骨折固定、积极抗休克、二次查体和实施一体化院前院内救治等方面进一步改进, 提高救治成功率。Abstract: Objective To study and analyze the risk factors for multiple injuries, in order to provide guidance for pre-hospital emergency aid and improve the success rate of patients with multiple injuries.Methods A retrospective investigation was conducted on the epidemiological characteristics and pre-hospital treatment effect of 330 patients with multiple injuries admitted to our hospital from January 2017 to December 2021, and calculating the trauma index (TI).The patients whose TI value did not rise to the higher level of risk classification when delivered to the hospital after pre-hospital treatment were included in the effective group (n=208), and the patients whose TI value rose to the higher level of risk classification were included in the ineffective group (n=122).The influence of risk factors on the disease was analyzed by single factor screening and multivariate logistic regression analysis model.Results The main causes of the injuries were traffic injuries (70.3%) and falling injuries (22.4%); More common in men (74.5%).Patients ≥60 years of age, number of trauma sites ≥3, response time ≥30 min, oxygen saturation < 94%, shock index (SI)≥1.5, hypothermia and TI >16 were classified as risk factors in patients with multiple injuries (P < 0.05).Conclusion Patients with multiple injuries have rapid disease progression and a high risk of death when patients ≥60 years of age, number of trauma sites ≥3, response time ≥30 min, oxygen saturation < 94%, SI ≥1.5, hypothermia and TI >16.Pre-hospital emergency doctors should attach great importance to it, and make further improvements in effective hemostasis, reliable fracture fixation, active anti-shock, secondary physical examination and integrated pre-hospital treatment, so as to improve the success rate of treatment.
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Key words:
- multiple injury /
- risk factors /
- treatment /
- pre-hospital care
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表 1 2组基线资料比较
例(%)，X±S 因素 有效组
(n=208)无效组
(n=122)χ2/Fisher/t P 性别 0.031 0.812 男 156(75.0) 90(73.8) 女 52(25.0) 32(26.2) 年龄/岁 43.34±5.23 60.47±4.35 9.996 0.001 < 60 142(68.3) 52(42.6) 10.438 0.001 ≥60 66(31.7) 70(57.4) 致伤原因 0.498a) 0.963 交通伤 148(71.2) 84(68.9) 坠落伤 44(21.1) 30(24.6) 利器/钝器伤 12(5.8) 6(4.9) 挤压/爆炸伤 4(1.9) 2(1.6) 创伤部位 2.309 0.697 头面颈部 90(43.3) 98(80.3) 胸部 56(26.9) 42(34.4) 腹部 50(24.0) 44(36.1) 四肢(包括骨盆) 136(65.4) 100(82.0) 脊柱 16(7.7) 12(9.8) 创伤部位数量 9.629 0.002 < 3处 140(67.3) 52(42.6) ≥3处 68(32.7) 70(57.4) 转运到达时间/min 29.246 < 0.001 < 30 160(76.9) 42(34.4) ≥30 48(23.1) 80(65.6) 指氧饱和度/% 18.967 < 0.001 < 94 52(25.0) 72(59.0) ≥94 156(75.0) 50(41.0) SI 14.497 < 0.001 < 1.5 132(63.5) 40(32.8) ≥1.5 76(36.5) 82(67.2) 低体温 6.028 0.014 是 106(51.0) 86(70.5) 否 102(49.0) 36(29.5) TI评分/分 14.253 < 0.001 ≤16 138(66.3) 44(36.1) >16 70(33.7) 78(63.9) 注：a)为Fisher确切概率，组间比较差异有统计学意义(P < 0.05)。 
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表 2 多发伤院前救治危险分级上升的多因素logistic回归分析
项目 B SE Wald χ2 P OR 95%CI 下限 上限 年龄≥60岁 2.446 0.720 11.552 0.001 1.044 0.985 3.321 创伤部位数量≥3处 1.886 0.618 9.315 0.002 2.676 1.538 6.653 转运到达时间≥30 min 0.874 0.304 6.613 0.010 1.332 1.065 4.357 指氧饱和度 < 94% 0.359 0.106 5.046 0.025 1.985 0.836 4.691 SI≥1.5 1.413 0.312 20.535 < 0.001 6.613 2.612 12.538 低体温 1.941 0.793 5.994 0.014 3.573 1.026 6.463 TI评分>16分 1.078 0.336 10.316 0.001 4.835 1.139 8.371
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表 3 多发伤院前救治危险分级上升的相关危险因素ROC分析
项目 AUC 95%CI 截断值 灵敏度 特异度 SI 0.901 0.826~0.957 1.58 0.863 0.856 TI评分 0.866 0.784~0.921 16.57 0.825 0.772 创伤部位数量 0.824 0.698~0.874 3.25 0.834 0.725 体温 0.781 0.624~0.804 35.51 0.802 0.681 指氧饱和度 0.757 0.652~0.782 93.33 0.782 0.707 转运到达时间 0.739 0.679~0.771 34.72 0.703 0.724 年龄 0.712 0.611~0.764 62.35 0.681 0.635
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