四肢战创伤院内死亡原因及危险因素的logistic回归分析

目的 探讨四肢战创伤病例中院内死亡的死亡原因及危险因素.方法 对1968年至2002年在战伤救治过程中收治的352例四肢战创伤病例进行回顾性研究,对15例死亡病例尸体剖解结果进行分析以探讨其死亡原因,并采用logistic回归模型对死亡的危险因素进行了多因素统计学分析.以探讨影响死亡的危险因素.结果 352例在院病例中死亡15例,病死率为4.3%.死亡原因主要有急性肾功能衰竭(ARF)7例(46.7%),肺栓塞3例(20.0%),多器官功能衰竭(MOSF)2例(13.3%),气性坏疽3例(20.0%),其中气性坏疽合并ARFl例,合并MOSF 1例.死亡的主要危险因素有:休克、截肢(χ2=93.589、144.716,均P<0.05).结论 四肢战创伤病例主要死亡原因为ARF,对休克病人的及时正确处理以及截肢时机的正确选择有利于减少死亡率.

The causes of death and risk factors in pafients of war wound and trauma of extremities by logistic regression model

Objective To explore the causes of death and risk factors in patients of war wound and trauma of extremities.Methods This retrospective study involved 352 patients of war wound and trauma of extremities admitted to 303rd Hospital of People's Liberation Army during the period between 1968 to 2002.All the data were reviewed and the causes of death of 15 patients were analyzed by autopsy, and a computer's logistic regression model analysis was performed to approach the risk factors of death.Results Fifteen of the three hundred and fifty-two patients were died (4.3 % ).The causes of death included acute renal failure(ARF) (46.7%,7/15), lung embolism( 20.0%,3/15), clostridial myonecrosis(20.0%,3/15) and multiple organ system failure (MOSF)(13.3%, 2/15 ).In the univariate analysis, the risk of death increased by shock, time admitted to hospital, amputation,time of tourniquet,associated injury of head, thoracic region, abdomen or blood vessel (P < 0.05 ).In the logistic regression model analysis, shock and amputation were the two factors most strongly associated with the death of patients of war wound and trauma.(P < 0.05).Conclusion Acute renal failure(ARF) was the main cause of death of patients of war wound and trauma of extremities.Its should be helpful for minimize the mortality of patients of war wound and trauma to manage the shock in time and have a correct choice of amputation promptly.