Analysis Of Fatal Factors Of In The Patients With Traumatic Pelvis Fractures And Perineal Injuries

Purpose:To study the fatal factors of the patients with traumatic pelvis fractures and perineal injuries and improve the treatment.Methods:This topic was the retrospective observation study.The clinical data of the patients with traumatic pelvis fractures and perineal injuries were collected from the Zhejiang University the second affiliated Hospital and Ningbo zhenhai People Hospital during January 2010 and March 2018.We reviewed the medical records that enabled the inclusion standards from the Medical Record Department of two hospitals,and collected the indices as follows:gender,age,trauma mechanism,pelvic fracture type(Tile),MOTS-RTS,ISS,GCS,APACH ?,SOFA,the worst value of Lactic acid,the total red cell transfusion volume(U)within the first three days after admission,the hemorrhagic shock,shock index,the area and depth of perineal injury,associated injury,the enterostomy,wound drainage,the worst CRP value,the worst PCT value,sepsis and sepsis shock,the length of ICU stay,the total length of hospital stay,treatment outcome.Data were collected using Exce12007.The statistical analysis was performed using SPSS22.0 software.Results:A total of 81 patients with perineal trauma were included in this study,with an average age of 39.83±17.68 years old,male 66 cases(81.48%)and female 15 cases(18.52%).Of the 81 patients,there were 58 cases(71.60%)of the patients with pelvic fracture and perineal injury died 12 cases,while the 23(28.40%)patients with pure perineal injury were no dead.The fatal causes of 12 patients with pelvic fracture and perineal injury(mortality rate of 20.69%,12/58)were 7 cases of the hemorrhagic shock and 5 cases of the septic shock complicated by multiple organ failure.The dead patients with type C pelvic fractures were accounted for 91.67%(11/12).The MOTS-RTS,ISS,GCS,APACHII,SOFA,the shock index,the perineal injury area,the worst CRP,the worst PCT,the worst lactate of the non-dead group and the dead group were 7.03±1.36 vs 2.72±1.06,27.46±14.87 vs 60.92±5.93,12.96±3.45 vs 4.08±1.73,12.85±8.96 vs 33.00±5.83,6.74±5.96 vs 16.67±2.10,1.06±0.43vs1.76±0.45,54.68 ± 112.13cm2 vs265.29 ± 301.65cm2,96.42 ± 80.23mg/Lvs 231.63 ±169.14mg/L,1.87±4.08 ng/mL vs 16.02±26.99 ng/mL?2.08±1.30mmol/L vs 18.92± 6.51mmol/L,respectively.The ISS,APACHII,SOFA,the shock index,the perineal injury area,the worst CRP,the worst PCT and the worst lactate of the dead group were higher than those of the non-death patients,and MOTS-RTS,GCS were lower.There was statistically significant difference between the two groups.Conclusion:The fatal causes of the patients with pelvic fracture and perineal injury were mainlythe refractory hemorrhagic shock in earlier period and the septic shock complicated by multiple organ failure.The type C pelvic fractures,hemorrhagic shock,repeated infections,the septic shock complicated by multiple organ failure could increase the risk of death in the patients with perineal wound.It would be help reduce the mortality to monitor the indices of hemorrhage,infection,shock,such as MOTS-RTS,GCS and SI,ISS,APACHII,SOFA,the worst CRP,the worst PCT,the worst lactic acid,effectively control of active bleeding and infection.