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目的分析影响严重多发伤并发急性肺损伤(ALI)及急性呼吸窘迫综合征(ARDS)生存率的危险因素。方法回顾性分析171例并发ALI/ARDS的严重多发伤患者资料(ALI组76例,ARDS组95例),对影响其生存率的20项可能危险因素进行多因素逐步Logistic回归分析。结果影响ALI组生存率危险因素为吸烟(B=-5·235,OR=0·005,P=0·001)、创伤后继发脓毒症(B=-2·753,OR=0·064,P=0·031)、胃肠出血(B=-2·876,OR=0·056,P=0·033);影响ARDS组生存率危险因素为:诱因持续到发病时间(B=3·524,OR=33·933,P=0·008)、创伤后继发脓毒症(B=-5·183,OR=0·006,P=0·004)、肾功能不全(B=-4·745,OR=0·009,P=0·009)、胃肠出血(B=-6·335,OR=0·002,P=0·007)。结论不同于传统ALI/ARDS研究,本研究发现吸烟可能成为影响生存率的独立危险因素;在严重多发伤条件下,并发ALI/ARDS的发病时间愈早,预计的生存率可能愈低;在肺受到损害条件下,如果并发肾功能不全,极易诱发MODS;脓毒症和胃肠出血仍然是创伤后影响生存率的感染性或诱发感染的危险因素,对导致感染的原发病必须积极治疗。
Objective To analyze the risk factors affecting the survival rate of patients with severe multiple traumatic injury complicated with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Methods A retrospective analysis of 171 patients with severe multiple traumatic injuries complicated by ALI / ARDS (76 in ALI group and 95 in ARDS group) was performed. Logistic regression analysis of 20 possible risk factors influencing their survival rate was performed. Results The risk factors of survival in ALI group were smoking (B = -5.235, OR = 0.005, P = 0.001), sepsis secondary to trauma (B = -2.753, OR = 0.064 (P = 0.031) and gastrointestinal bleeding (B = -2.876, OR = 0.056, P = 0.033). The risk factors influencing the survival rate of ARDS group were as follows: the predisposing duration to the onset time (B = 3 OR = 33.933, P = 0.008), secondary sepsis after trauma (B = -5 · 183, OR = 0.006, P = 0.004), renal insufficiency (B = 4 · 745, OR = 0 · 009, P = 0 · 009), gastrointestinal bleeding (B = -6 · 335, OR = 0.002, P = 0.007). Conclusions Unlike traditional ALI / ARDS studies, this study found that smoking may be an independent risk factor for survival; in the case of severe multiple trauma, the onset of concurrent ALI / ARDS may be earlier and the predicted survival rate may be lower; In compromised conditions, MODS can be easily induced if renal insufficiency is present; sepsis and gastrointestinal bleeding are still risk factors for infectious or induced infection that affect survival after trauma and are actively treated for the primary disease that leads to infection .