ABSTRACT
Objective:To investigate the sex differences in severe traumatic death patients of different ages.Methods:A total of 408 patients with severe trauma who received treatment in The Second Affiliated Hospital of Zhejiang University School of Medicine and Taizhou First People's Hospital from June 2017 to June 2022 were retrospectively analyzed. These patients were divided into the children group (≤ 14 years old, n = 47), the adult group (14-50 years old, n = 171), and the older adult group (> 50 years old, n = 90). Multivariate logistic regression was used to evaluate the difference in sex-based mortality among the groups. Nonlinear regression was used to evaluate the mutual interaction of increasing age and sex on the predicted survival rate. Results:Traffic accidents were the most common cause of death among men in the adult group (58.93%, χ2 = 7.95, P = 0.027). Falls were the most common cause of death among men in the older adult group (57.36%, χ2 = 8.63, P = 0.001). The Injury Severity Score of women in the adult and older adult groups was significantly higher in women than that of men in the same group [adult group: men: (24.39 ± 4.17) points, women: (26.32 ± 4.31) points, t = 2.84, P = 0.005). The incidence of post-traumatic complications in the older adult group was very higher in men than in women (respiratory failure: 28.68% in men, 14.75% in women, χ2 = 4.37, P = 0.036; circulatory failure: men: 27.13%, women: 13.11%, χ2 = 4.64, P=0.031; neuropsychiatric disorders: men: 20.93%, women: 8.20%, χ2 = 4.79, P = 0.029; respiratory infection: men: 31.78%, women: 18.03%, χ2 = 5.55, P = 0.047; other infectious diseases: men: 28.68%, women: 13.11%, χ2 = 0.69, P = 0.018). After adjusting for covariates, the mortality rate of men in the older adult group was significantly higher than that of women in the same group ( OR: 1.261, 95% CI: 1.185-1.343, P < 0.001). With the increase of age, the predicted survival rate after the trauma in patients of different sexes also decreased, in particular in men aged > 50 years (interaction P = 0.051). Among patients with blunt and severe head trauma, age-related mortality decline in patients aged > 50 years had a strong interaction with sex (interaction P = 0.002). In patients with penetrating trauma, there was a weak interaction between the predicted survival rate of different sexes (interaction P = 0.192). Conclusion:There is no significant difference in age-related change in post-traumatic mortality between different sexes. In the population aged > 50 years, men have a relatively higher risk of death than women.
ABSTRACT
Objective To investigate the effect of intravenous thrombolysis with different doses of alteplase on neurological function in patients with acute ischemic stroke.Methods 120 patients with acute ischemic stroke were selected as the research subjects.According to the admission time,the patients were divided into the observation group and the control group,60 patients in each group.The observation group was treated with low dose alteplase(0.6mg/kg),the control group was given standard dose(0.9mg/kg).The clinical curative effect,incidence rate of adverse event,NIHSS score and mRS score before and after treatment were observed and recorded in the two groups.Results Before treatment,there was no significant difference between the two groups in NIHSS score(t=0.288 0,P=0.773 9).After treatment for 3 days,the NIHSS score of the control group decreased compared with before treatment,and was lower than that of the observation group at the same period,there was significant difference between the two groups(t=0.778 5,P=0.000 0).Before treatment,the mRS score between the two groups had no siginificant difference(t=0.801 0,P=0.424 7).After treatment for 90 days,the mRS score of the two groups decreased,the difference was statistically significant(t=6.811 5,P=0.000 0).After treatment,1 patient with cerebral hemorrhage was observed in the observation group,while 3 cases in the control group,the difference between the two groups was not statistically significant(χ2=1.034 5,P=0.309 1).The mortality of the observation group was 11.47％,which of the control group was 1.67％,there was significant difference between the two groups(χ2=4.821 4,P=0.028 1).The good prognosis rate of the observation group was 45％,which of the control group was 68.33％,the difference was significant between the two groups (χ2=6.651 6,P=0.009 9).Conclusion Standard dose of alteplase in the treatment of acute ischemic stroke has better efficacy than low-dose alteplase,it has improved conditions of neurological deficits in patients,better recovery of neurological function,the prognosis is good,it can be widely recommended.