四种危重病评分方法对颅脑外伤病人病情评估价值的比较  

Comparison of Four of Scoring Systems in Evaluating Severity and Prognosis of Patients with Traumatic Brain Injury

作　　者：何卫平[1] 孟新科[1] 郑鹏[1] 申群喜[1] 彭雅君[1] 张继文[1] 陈楷株[1] 

机构地区：[1]深圳市第二人民医院急诊科,518000

出　　处：《岭南急诊医学杂志》2002年第2期84-86,91,共4页Lingnan Journal of Emergency Medicine

摘　　要：目的:比较GCS、APACHEⅡ、APACHEⅢ、SIRS四种评分方法对颅脑外伤病人病情评估价值。方法:回顾分析314例颅脑外伤病人的临床资料,分别进行GCS、APACHEⅡ、APACHEⅢ、SIRS评分。比较病死组与存活组之间各评分分值的差异;比较每种评分各分值段之间病人病死率的差异;以ROC曲线下面积的大小衡量各评分系统区别该类病人病死与存活的能力。结果:存活组病人GCS、APACHEⅡ、APACHEⅢ、SIRS评分分别为10.6±4.4,7.2±5.9,25.6±21.4,1.3±0.0;病死组分别为4.9±2.5,17.7±6.1,60.8±20.9,2.1±0.0,两组之间比较,差异均有统计学意义(P<0.01)。不同评分系统各分值段病人病死率比较,差异均有统计学意义(P<0.01)。即随APACHEⅡ、APACHEⅢ、SIRS各评分系统分值增加,GCS评分系统分值降低,病人病死率相应升高。GCS、APACHEⅡ、APACHEⅢ、SIRS评分ROC曲线下面积分别为0.901,0.884,0.847,0.649,其中以GCS评分最大,SIRS评分最小。结论:四种评分方法均可在一定程度上评估颅脑外伤病人的病情,预测其预后,其中仍以GCS评分效力最大,SIRS评分效力最小,临床应用宜以GCS评分首选。Objective: To compare the performance of GCS, APACHE Ⅱ、 APACHE Ⅲ、SIRS scoring systems on evaluating severity and prognosis in a retrospective series of patients with traumatic brain injury. Methods: Clinic data of 314 patients during the hospitalized first 24hrs were recorded and scored with GCS, APACHE Ⅱ, APACHE Ⅲ, SIRS score respectively. Scores were compared between survivors group and non-survivors group. Mortality were contrasted among different scoring stages of the four scoring systems respectively. Areas under of ROC of the four scoring systems were measured and compared. Results: A significantly difference was found between non-survivors group and survivors group on the score of patients scored by GCS, APACHE Ⅱ, APACHE Ⅲ, SIRS scoring systems respectively( P<0. 01 ). The scores in non-survivors group (17.7±6. 1 for APACHE Ⅱ, 60.8±20.9 for APACHE Ⅲ, 2.1±0. 0 for SIRS) were higher than that of in survivors group (7.2± 5.9 for APACHE Ⅱ, 25.6±21.4 for APACHE Ⅲ, 1.3 + 0. 0 for SIRS) . The results showed that the mortality increased along with elevation of the scores of APACHE Ⅱ, APACHE Ⅲ, SIRS scoring systems and decrease of the score of GCS scoring systems. The areas under of ROC of GCS, APACHE Ⅱ, APACHE Ⅲ, SIRS scoring systems were 0. 901, 0. 884, 0. 848, 0,649 respectively. The area under of ROC of SIRS is less than that of the other three scoring systems significantly. The area under of ROC of GCS was the biggest one. Conclusions: All four prognostic scoring systems may be used to evaluate severity of disease in patients with traumatic brain injury, as well as to predict prognosis of them. For these usefulness, GCS score is superior than the other three scoring systems.

关 键 词：颅脑外伤 GCS APACHEⅡ APACHEⅢ SIRS评分 

分 类 号：R651[医药卫生—外科学]