摘要
目的 分析探讨车祸致下胸部肋骨骨折患者并发腹腔脏器损伤的危险因素.方法 选取 2021 年 4月至 2022 年 4 月河南科技大学第一附属医院收治的 180 例车祸致下胸部肋骨骨折患者作为研究对象,收集患者性别、年龄、体重指数、收缩压、心率、车祸类型、肋骨骨折类型、骨折肋骨数目、是否合并多发腰椎横突骨折、腹部体征、入院时红细胞比容(HCT)以及腹腔脏器损伤情况等资料,并根据并发腹腔脏器损伤情况运用倾向性评分匹配法获得均衡标本,将其设定为发生组和未发生组,多因素Logistic回归分析车祸致下胸部肋骨骨折患者并发腹腔脏器损伤的危险因素.结果 180 例车祸致下胸部肋骨骨折患者中 71 例并发腹腔脏器损伤、109 例未并发腹腔脏器损伤,倾向性评分匹配法进行配对(1∶1,卡钳值=0.01)后得出发生组 41 例、未发生组 41例.单因素分析结果显示,发生组肋骨骨折类型为双侧、合并多发腰椎横突骨折、腹部体征为阳性及HCT异常降低的患者比例均明显高于未发生组(χ2=6.609、6.032、11.039、8.323,P=0.010、0.014、0.001、0.004).多因素Logistic回归分析结果显示,双侧下胸部肋骨骨折、合并多发腰椎横突骨折、腹部体征阳性、HCT异常降低是车祸致下胸部肋骨骨折患者并发腹腔脏器损伤的独立危险因素(95%CI 为 1.353～20.306、1.240～7.692、1.923～16.046、1.505～9.475,P=0.017、0.015、0.002、0.005).结论 双侧下胸部肋骨骨折、合并多发腰椎横突骨折、腹部体征阳性、HCT异常降低是车祸致下胸部肋骨骨折患者并发腹腔脏器损伤的独立危险因素,临床应予以高度重视,及早进行干预,以提高患者预后.
Abstract
Objective To analyze the risk factors for concomitant abdominal organ injury in patients with lower thoracic rib fractures caused by traffic accidents.Methods 180 patients with lower thoracic rib fractures caused by traffic accidents,admitted to The First Affiliated Hospital of Henan University of Science and Technology from April 2021 to April 2022,were selected as research subjects and patients'data were collected,including sex,age,body mass index,systolic blood pressure,heart rate,type of traffic accident,type of rib fracture,number of fractured ribs,with multiple lumbar transverse process fractures or not,abdominal signs,hematocrit(HCT)on admission,and concomitant abdominal organ injury,etc.Propensity score matching was used to balance the subjects based on the occurrence of their abdominal organ injuries,and accordingly the patients were divided into the occurrence group and the non-occurrence group.Multivariate Logistic regression analysis was conducted to analyze the risk factors for concomitant abdominal organ injury in patients with lower thoracic rib fractures caused by traffic accidents.Results Among the 180 patients with lower thoracic rib fractures caused by traffic accidents,there were 71 cases complicated with abdominal organ injuries and the other 109 patients did not suffer abdominal organ injuries.After the propensity score matching(matched by 1∶1,caliper width=0.01),there were respectively 41 cases being set in the occurrence group and the non-occurrence group.The results of the univariate analysis showed that the proportions of patients with bilateral rib fractures,with multiple lumbar transverse process fractures,positive abdominal signs,and abnormally low HCT were significantly higher in the occurrence group compared with the non-occurrence group(χ2=6.609,6.032,11.039 and 8.323,P=0.010,0.014,0.001 and 0.004).Multivariate Logistic regression analysis showed that bilateral lower thoracic rib fractures,with multiple lumbar transverse process fractures,positive abdom-inal signs,and abnormally low HCT were independent risk factors for the occurrence of abdominal organ injury in patients with lower thoracic rib fractures caused by traffic accidents(95%CI:1.353-20.306,1.240-7.692,1.923-16.046,1.505-9.475,P=0.017,0.015,0.002 and 0.005).Conclusion Bilateral lower thoracic rib fractures,with multiple lumbar transverse process fractures,positive abdominal signs,and abnormally low HCT were independent risk factors for the occurrence of abdominal organ injury in patients with lower thoracic rib fractures caused by traffic accidents.Attention should be paid to and timely intervention should be performed on this regard in clinical practice to improve the prognosis of such patients.
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