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压力下的风险:严重受伤的创伤患者的胃肠道出血
Stacey N Lynch1, Maici Craig2, George Michael2
1Division of Trauma/Surgical Critical Care, University of Tennessee Health Science Center, Memphis, Tennessee.
Journal of the American College of Surgeons
|September 9, 2025
概括
胃肠道出血 (GiB) 影响了重症创伤患者. 男性性别,血管压缩剂使用和置换疗法是该人群中GiB的关键危险因素.
科学领域:
- 关键护理医学 关键护理医学
- 创伤外科 手术 创伤外科
- 胃肠病学 胃肠病学
背景情况:
- 胃肠道出血 (GiB) 是重症监护中的已知并发症,与低输液和粘膜屏障功能障碍有关.
- 虽然GiB的风险因素在一般人群中得到研究,但在重症创伤患者中,人们对其理解较少.
- 本研究侧重于创伤重症监护室 (TICU) 患者中GiB的发病率和特定风险因素.
研究的目的:
- 为了确定在重症创伤患者中GiB的发病率.
- 在这个特定的患者队列中确定与GiB相关的独立风险因素.
- 为GiB在创伤重症监护中的预防策略提供信息.
主要方法:
- 从2019年3月到2023年7月入住一级创伤中心TICU的患者的回顾性分析.
- 纳入标准:机械通风时间超过48小时.
- 病例对照分析 (1:3年龄匹配) 将GiB患者与对照进行比较,使用条件逻辑回归来确定预测因素.
主要成果:
- 总共有2,289名患者被审查,其中64名被确定为GiB (48名临床显著).
- 独立的GiB预测因素包括男性性别 (AOR=3.12),血管压缩剂使用 (AOR=3.16),皮质类固醇使用 (AOR=2.45),需要脏替代疗法 (AOR=3.54),以及肠道营养不耐受 (AOR=3.86).
- 整体创伤人群的平均年龄为41岁,受伤严重程度得分为22岁,死亡率为21%.
结论:
- 胃肠道出血在重症创伤患者中仍然是一个重大问题.
- 识别该群体中独特的风险因素对于早期检测和有针对性的预防措施至关重要.
- 进一步的研究可能会导致改善GiB在创伤重症监护机构的发病率减少策略.
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