Risk factors and therapeutic strategies for severe multi-trauma complicated with multiple organ dysfunction syndrome in early stage at high altitude

Abstract

Objective To explore the risk factors and therapeutic strategies for severe multi-trauma complicated with mul-tiple organ dysfuncfion syndrome(MODS)at high altitudes.Methods Patients included 93 cases(group A)and 98 cases(group B) with severe trauma admitted from January 2003 to December 2004 and from January 2005 to December 2007,respectively.Age,gender,acute physiology and chronic healthy score(APACHE Ⅱ),injury severity score(ISS),hypoxia.shock,sepsis,co-aggulation disorders,abdomen compartment syndrome (ACS),blood glucose were analyzed for both groups using logistic analysis.Risk factors affecting the mortality of severe trauma in terms of treatment were analyzed.Results 45(45/93)cases in group A and 48(48/98)cases in group B were complicated with MODS in early stage.The conditions were more severe in patients with MODS than those in patients without MODS with regard to shock,hypoxia,ACS,coagulalion disorders,APACHE Ⅱ,ISS.and the difference were significant(P<0.01).The mortality in group B was lower than that in group A beeause of improved thera-peutic stregies including CBP,appropriate management of shock,corrective coagulation disorders,target glucose control, full sedation analgesia,inhibiting inflammation,ventilation and sufficient liquid resuscitation,the difference was significant(P<0.01).Logistic multiple regression analysis showed that all of risk factors were higher than in the patients of shock,hypoxia,septic shoek Cpmclusion Shock,hypoxia,sepsis and strategy of clinical treatment are coralated with multi-trauma complicated with MODS in eady stage high altitudes.Correcting hypoxia,shock and coagulation disorders,sufficient fluid resuscitation,target glucose control,full sedation analgesia,and inhibiting inflammation are the crux of preventing MODS in early multi-trauma pa-tients. Key words: Multi-trauma; Multiple dysfunction syndrome; Risk factors; Mortality; High ahitude