对老年重创患者创伤引起的凝血病风险因素的分析
Yangbo Kang1,2,3, Qi Yang1,2,3, Hongbo Ding1,2,3
1Department of Emergency Medicine, the Second Affiliated Hospital Zhejiang University School of Medicine / Institute of Emergency Medicine of Zhejiang University, Hangzhou 310009, China.
World journal of emergency medicine
|November 27, 2024
概括
老年患者的创伤诱导凝血病 (TIC) 与较高的损伤严重程度得分和冲击指数有关. 酸化症,低血症和低纤维素生成症是重大创伤后发展TIC的关键危险因素.
科学领域:
- 创伤和紧急医疗医学
- 血液学和凝血障碍 血液学和凝血障碍
- 老年人重症监护中心的重症监护服务.
背景情况:
- 创伤引起的凝血病 (TIC) 在严重受伤的老年患者中显著增加死亡率和发病率.
- 在这个人口群体中,有助于ICT的风险因素仍然不完全理解.
- 这项研究调查了老年人中重大创伤病例中TIC的特定风险因素.
研究的目的:
- 确定和分析与老年患者创伤诱导凝血病 (TIC) 相关的独立风险因素.
- 在这个脆弱的患者群体中开发ICT的预测模型.
- 通过了解老年创伤患者凝血病的预测因素来改善临床结果.
主要方法:
- 对2015年1月至2020年9月期间入院的老年创伤患者进行了一项回顾性研究.
- 人口统计数据,损伤特征,治疗干预措施和临床结果从电子病历中提取.
- 使用多变量逻辑回归和ROC曲线分析来识别独立的风险因素并评估模型性能.
主要成果:
- 在371名老年创伤患者中,34.8%被诊断为TIC.
- 较高的伤害严重性得分 (ISS) 和冲击指数 (SI) 与TIC有显著的关联.
- 在TIC组中观察到较低的血清,纤维素水平和基过量 (BE).
- 确定的独立风险因素包括ISS>16,SI>1,低BE,低血和低纤维素生成血.
- 预测模型表现出强的性能,AUC为0.887.
结论:
- 升高的ISS (>16) 和SI (>1) 是老年创伤患者TIC风险的重要指标.
- 代谢障碍,如酸症 (低BE),低血症和低纤维素生成血症是TIC的关键独立风险因素.
- 这些发现可以帮助在老年创伤患者中早期识别和管理TIC.
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