摘要
目的:探讨创伤出血性休克后急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的危险因素.方法:回顾性研究2012年12月至2021年8月期间共314名创伤出血性休克患者,其中男性患者152名,女性患者162名,年龄中位数为63.00(49.75～82.00)岁.记录患者住院期间的各项临床指标,根据入院7 d内是否发生ARDS将患者分为两组,即ARDS组(n=89)和非ARDS组(n=225),通过判定差异寻找ARDS的危险因素,并建立预测是否出现ARDS的回归模型.结果:创伤出血性休克后ARDS的发生率为28.34％,Logistic回归模型分析发现创伤出血性休克后ARDS的独立危险因素包括男性、冠状动脉粥样硬化性心脏病(简称冠心病)史、高急性生理与慢性健康评分Ⅱ(acute physiology and chronic health evaluation Ⅱ,APACHE Ⅱ)、受伤原因为车祸伤和肌钙蛋白Ⅰ升高,各独立危险因素的OR值及95％可信区间(confidence intervals,CI)分别为4.01(95％CI:1.75～9.20)、5.22(95％CI:1.29～21.08)、1.07(95％CI:1.02～1.57)、2.53(95％CI:1.21～5.28)和 1.26(95％CI:1.02～1.57),P值分别为0.001、0.020、0.009、0.014和0.034.预测创伤出血性休克后ARDS的受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under curve,AUC)分别为:男性 0.59(95％CI:0.51～0.68)、冠心病史 0.55(95％CI:0.46～0.64)、APACHE Ⅱ 评分 0.65(95％CI:0.57～0.73)、受伤原因为车祸伤 0.58(95％CI:0.50～0.67)、肌钙蛋白Ⅰ 0.73(95％CI:0.66～0.80),总体预测值为 0.81(95％CI:0.74～0.88).结论:ARDS 在创伤出血性休克患者中发生率较高,男性、冠心病史、高APACHE Ⅱ评分、受伤原因为车祸伤和肌钙蛋白Ⅰ升高是创伤出血性休克后ARDS的独立危险因素,及时监测这几项指标有利于早期识别和治疗创伤出血性休克后ARDS.
Abstract
Objective:To investigate the risk factors of acute respiratory distress syndrome(ARDS)after traumatic hemorrhagic shock.Methods:This was a retrospective cohort study of 314 patients with traumatic hemorrhagic shock at Trauma Medicine Center,Peking University People's Hospital from De-cember 2012 to August 2021,including 152 male patients and 162 female patients,with a median age of 63.00(49.75-82.00)years.The demographic data,past medical history,injury assessment,vital signs,laboratory examination and other indicators of these patients during hospitalization were recorded.These patients were divided into two groups,ARDS group(n=89)and non-ARDS group(n=225)ac-cording to whether there was ARDS within 7 d of admission.Risk factors for ARDS were identified using Logistic regression.The C-statistic expressed as a percentage[area under curve(AUC)of the receiver operating characteristic(ROC)curve]was used to assess the discrimination of the model.Results:The incidence of ARDS after traumatic hemorrhagic shock was 28.34％.Finally,Logistic regression model showed that the independent risk factors of ARDS after traumatic hemorrhagic shock included male,histo-ry of coronary heart disease,high acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,road traffic accident and elevated troponin Ⅰ.The OR and 95％confidence intervals(CI)were 4.01(95％CI:1.75-9.20),5.22(95％CI:1.29-21.08),1.07(95％CI:1.02-1.57),2.53(95％CI:1.21-5.28),and 1.26(95％CI:1.02-1.57),respectively;the P values were 0.001,0.020,0.009,0.014,and 0.034,respectively.The ROC curve was used to analyze the value of each risk factor in predicting ARDS.It was found that the AUC for predicting ARDS after traumatic hemor-rhagic shock was 0.59(95％CI:0.51-0.68)formale,0.55(95％CI:0.46-0.64)for history of coronary heart disease,0.65(95％CI:0.57-0.73)for APACHE Ⅱ score,0.58(95％CI:0.50-0.67)for road traffic accident,and 0.73(95％CI:0.66-0.80)for elevated troponin Ⅰ,with an overall predictive value of 0.81(95％CI:0.74-0.88).Conclusion:The incidence of ARDS in pa-tients with traumatic hemorrhagic shock is high,and male,history of coronary heart disease,high APACHE Ⅱ score,road traffic accident and elevated troponin Ⅰ are independent risk factors for ARDS after traumatic hemorrhagic shock.Timely monitoring these indicators is conducive to early detection and treatment of ARDS after traumatic hemorrhagic shock.
基金项目
横向科研课题(2022-Z-42)
北京大学人民医院研究与发展基金(RDJ2022-26)
维普
万方数据