| 四肢多发骨折并发胸腔积液的危险因素分析 |
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投稿时间：2021-06-20
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| 作者 | Author | 单位 | Unit | E-Mail |
| 谭亮 |
TAN Liang |
南京中医药大学中西医结合鼓楼临床医学院, 江苏 南京 210008
南京中医药大学附属徐州市中医院, 江苏 徐州 221000 |
Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing 210008, Jiangsu, China |
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| 张子韬 |
ZHANG Zi-tao |
南京中医药大学中西医结合鼓楼临床医学院, 江苏 南京 210008
南京大学医学院附属鼓楼医院, 江苏 南京 210008 |
Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing 210008, Jiangsu, China |
nanjingzhangzitao@126.com |
| 邱旭升 |
QIU Xu-sheng |
南京中医药大学中西医结合鼓楼临床医学院, 江苏 南京 210008
南京大学医学院附属鼓楼医院, 江苏 南京 210008 |
Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing 210008, Jiangsu, China |
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| 陈一心 |
CHEN Yi-xin |
南京中医药大学中西医结合鼓楼临床医学院, 江苏 南京 210008
南京大学医学院附属鼓楼医院, 江苏 南京 210008 |
Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing 210008, Jiangsu, China |
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| 期刊信息：《中国骨伤》2022年35卷，第7期，第692-697页 |
| DOI：10.12200/j.issn.1003-0034.2022.07.019 |
| 基金项目:国家自然科学基金面上项目（编号：81871762）；十三五南京市青年卫生人才培养工程（编号：QRX17050） |
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目的:探讨四肢骨折合并胸腔积液的危险因素，为预防胸腔积液的发生提供参考。
方法：自2010年1月至2019年12月采用手术治疗的137例四肢多发骨折患者，男102例，女35例，年龄16~92（48.34±15.85）岁。四肢多发骨折定义为全身有两处以上的四肢骨折，所有入选患者术前具有完整的临床，影像及实验室检查资料，包括术前胸部CT，性别，年龄，体质量指数（body mass index，BMI），红细胞压积（hematocrit，HCT），美国麻醉医师协会（American Society of Anesthesiologists，ASA）分级，创伤严重度评分（injury severity score，ISS），吸烟史，手术史，糖尿病史，高血压史，入院至手术时间，骨折部位，血小板计数，白蛋白，C-反应蛋白和D-二聚体等因素。记录患者是否合并胸腔积液，计算胸腔积液量，并对相关危险因素进行统计学分析。
结果：四肢骨折均接受了手术治疗，术后患者切口愈合良好，无伤口感染和急性肺损伤或急性呼吸窘迫综合征等并发症出现。通过多因素回归分析示：ISS>16分（P=0.000）、吸烟史（P=0.001）和肋骨骨折（P=0.000）是四肢多发骨折合并胸腔积液的危险因素。多因素线性回归分析显示：吸烟史，ISS及肋骨骨折是四肢多发骨折胸腔积液量增多的危险因素。
结论：四肢多发骨折合并胸腔积液与ISS、吸烟史以及肋骨骨折相关；胸腔积液量与吸烟史、ISS及肋骨骨折有关。对ISS>16分，有吸烟史或合并肋骨骨折的多发骨折患者应提高警惕，尽早干预，降低合并胸腔积液量的风险。 |
| [关键词]:四肢 骨折 胸腔积液 并发症 危险因素 |
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| Analysis of risk factors of multiple fractures of limbs complicated with pleural effusion |
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Abstract:
Objective: To explore the risk factors of limb fracture complicated with pleural effusion, and to provide reference for the prevention of pleural effusion.
Methods: From January 2010 to December 2019, 137 patients with multiple limb fractures were treated surgically, including 102 males and 35 females, aged 16 to 92(48.34±15.85) years. Multiple limb fractures were defined as more than two limb fractures in the whole body, so the selected patients had complete clinical, impact and laboratory examination data before operation, including preoperative chest CT, gender, age, body mass index(BMI), hematocrit(HCT), American Society of Anesthesiologists(ASA), injury severity score (ISS), smoking history of operation, history of diabetes, history of hypertension, admission to operation time, fracture site, platelet count, albumin, C-reactive protein and D-dimer. Whether the patient was complicated with pleural effusion, calculate the amount of pleural effusion were recorded, and the relevant risk factors were statistically analyzed.
Results: All limb fractures received surgical treatment. The incision healed well after operation, and there were no complications such as wound infection, acute lung injury or acute respiratory distress syndrome. Multivariate regression analysis showed that ISS higher than 16(P=0.000), smoking history(P=0.001) and rib fracture(P=0.000) were the risk factors of multiple limb fractures complicated with pleural effusion. Multivariate linear regression analysis showed that smoking history, ISS and rib fracture were the risk factors for the increase of pleural effusion in multiple limb fractures.
Conclusion: Multiple fractures of limbs combined with pleural effusion are related to ISS, smoking history and rib fracture;the amount of pleural effusion was related to smoking history, ISS and rib fracture. Patients with multiple fractures with ISS greater than 16, smoking history or rib fracture should be vigilant and intervene as soon as possible to reduce the risk of pleural effusion. |
| KEYWORDS:Extremities Fractures Pleural effusion Complications Risk factors |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 谭亮,张子韬,邱旭升,陈一心.四肢多发骨折并发胸腔积液的危险因素分析[J].中国骨伤,2022,35(7):692~697 |
| 英文格式: | TAN Liang,ZHANG Zi-tao,QIU Xu-sheng,CHEN Yi-xin.Analysis of risk factors of multiple fractures of limbs complicated with pleural effusion[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(7):692~697 |
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