脊柱损伤对严重创伤患者死亡率的影响:一种倾向匹配的队列研究
Han-Dong Lee1, KyoungWon Jung2, ByungHee Kang2
1Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea.
Medicine
|June 23, 2023
概括
脊髓损伤重创患者的死亡率较低,但在重症监护室停留时间较长. 脊柱损伤可以保护内部器官,减少严重创伤病例的整体死亡人数.
科学领域:
- 创伤外科 手术 创伤外科
- 整形外科手术 整形外科手术
- 紧急医疗 紧急医疗
背景情况:
- 严重的创伤,以伤害严重程度评分 (ISS) >15来定义,经常涉及脊髓损伤.
- 脊柱损伤对重大创伤患者死亡率的影响仍然不清楚,因为它被排除在ISS计算之外.
研究的目的:
- 调查脊柱损伤与严重创伤的成年患者的死亡率之间的关联.
- 为了比较包括死亡率,ICU停留时间 (LOS) 和严重创伤患者与没有脊髓损伤患者之间的死亡原因在内的结果.
主要方法:
- 对2893名成人重创患者的回顾性分析,这些患者于2016-2020年被录取到一级创伤中心.
- 1:1对脊柱损伤 (n=781) 和没有脊柱损伤 (n=2112) 的患者进行匹配,以比较结果.
- 分析包括伤害机制,死亡率,死亡原因,ICU LOS和呼吸机使用.
主要成果:
- 与匹配队列相比,脊髓损伤组的死亡率 (4.0%) 显著较低 (7.9%,P = .001).
- 脊椎损伤患者在重症监护室停留时间较长 (8.8天),而不是匹配队列 (7.2天,P = .028).
- 多器官衰竭 (MOF) 是脊髓损伤组 (41.9%) 的首要死亡原因,与匹配队列中 (61.3%) 中枢神经系统 (CNS) 损伤形成对比.
结论:
- 严重创伤患者的脊柱损伤与死亡率降低有关.
- 脊柱损伤可以作为其他内部器官的保护性"减震器",潜在地降低整体死亡率.
- 需要进一步的研究来了解这种保护作用背后的机制.
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