ABSTRACT
Objective To evaluate the prognosis-related factors of severe trauma in Intensive Care Unit,and to provide clinical reference for the diagnosis and treatment of severe trauma.Methods The clinical data of all 408 patients with severe trauma and ISS score ≥ 25 admitting to our ICU and from January 2011 to December 2015 were retrospectively analyzed.To summarize the epidemiological characteristics and compare gender,age,site of injury,cause of injury,duration,complications,treatment,ISS score and APACHE Ⅱ score between the improved group and the death or deterioration group.Results There were 332 people who were improved and 76 people who died or deteriorated.The patients of death and deterioration groups were older,has a higher proportion of self falls,environment disorder,shock,ARF,ARDS and MODS,more complications,and are more likely to accept mechanical ventilation,blood purification,CPR and lower GCS score and higher APACHE Ⅱ score.The improvement group has more sites of injury higher proportion of chest,limbs and pelvis injury,and is more likely to accept surgical operation and the longer hospital stay.Binary Logistic regression analysis shows that age ＞ 55,self falls,MODS,APACHE Ⅱ ＞ 20 and CPR are risk factors of death and deterioration for the severe trauma in ICU.Conclusion It's essential to pay more attention to the overall situation of patients,preventing complications,and protecting the function of organs during the treatment of severe trauma in ICU.
ABSTRACT
Objective To explore the risk factors in the prognosis of patients with severe multiple trauma related factors.Methods Ninety-three patients with severe multiple trauma(ISS score≥16 points) were selected as our subjects,who all hospitalized in the second hospital affiliated to Dalian medical University.Among of which,38 cases' ISS score was 16-25,and 55 cases' ISS score was higher and equal to 25.Clinical data and general information were recorded.ISS score,APACHE Ⅱ score and 6 h lactate clearance rate score were measured.Results Twenty-seven dead among these 93 cases and the mortality was 29.03％.There were significant differences in terms of ISS score,APACHE Ⅱ score,lactate level when entering ICU,6 h lactate level and 6 h lactate clearance rate between death patients (27 cases) and survival patients (66 cases) (t =9.846,9.812,7.112,7.012,9.831 ; P ＜ 0.001).In multiple organ dysfunction syndrome (MODS) patients,the mortality of ISS score:16-25 group was different from that of ISS score≥25 (15.78％ (6/38) vs.35.18％ (21/93),x2 =21.52,P ＜0.001).Among the 93 cases of severe multiple trauma,35 cases with MODS(37.6％ (35/93)),and 20 cases of which were dead(57.1％ (20/35)).There was statistic difference between MODS group(35 cases) and non-MODS(58 cases) in term of mortality(37.6％ (35/93) vs.12.1％ (7/58) ;x2 =21.52,P ＜ 0.001).Multivariate logistic regression analysis showed that the ISS score,APACHE Ⅱ score,6 h lactate clearance rate and MODS were independently prognostic correlation factors (P ＜ 0.05).Operating characteristic curve (ROC) showed that AUC of ISS score was 0.735 (95 ％ CI 0.629-0.842),of APACHE Ⅱ score was 0.888 (95％ CI 0.821 =0.956),of 6 h lactate clearance rate score was 0.951 (95％ CI 0.906 -0.997).Conclusion The factors of ISS score,APPCHE Ⅱ assessment,6 h lactate clearance rate,the occurrence of MODS are independent prognostic factors.