AIS 2005与AIS 1998在评价创伤救治结局中的应用比较  

Comparative study between AIS 1998 and AIS 2005 for evaluation of injury severity and major trauma outcome

作　　者：赵兴吉[1] 都定元[1] 孔令文[1] 张为民[1] 谭远康[1] 苏泓洁[1] 马丁[1] 

机构地区：[1]重庆市急救医疗中心胸心外科重庆市急救医学研究所,重庆400014

出　　处：《创伤外科杂志》2006年第3期198-201,共4页Journal of Traumatic Surgery

基　　金：卫生部科学研究基金资助项目(98-1-227);重庆市医学科学技术基金资助项目(01-1-005)

摘　　要：目的 比较简明损伤定级（AIS）2005与AIS 1998在评价创伤严重度及创伤救治结局的差异，探讨最新版AIS 2005应用的可行性及实用价值。方法 采用AIS 2005和AI S1998，对我院2003年1月-2005年5月救治的3110例创伤病例资料进行回顾性分析。结果 （1）随ISS值递增，两组病死率、并发症发生率均呈上升趋势；ISS〉20，AIS 2005组病死率上升趋势更为明显，在ISS〉15～≤20，AIS 2005组病死率较AIS 1998组有显著降低（P=0．001）。除AIS 2005组ISS≤15并发症发生率较AIS 1998组下降外（P=0．035），其余各ISS分值段AIS 2005组并发症发生率较AIS 1998组上升趋势更为明显。（2）随ISS值升高，修正创伤评分（RTS）、创伤与损伤严重度评分（TRISS）、创伤严重度特征评分（ASCOT）、ASCOT-CHINA值逐渐降低，且AIS 2005生存概率预测值分布较AIS 1998大。AIS 2005预测性评分指标的区别度和敏感性均高于AIS 1998，除ASCOT-CHINA准确性、ASCOT特异性低于AIS 1998，ASCOT存活误判率高于AIS 1998外，ASCOT、TRISS准确性，ASCOT-CHINA、TRISS特异性均高于AIS 1998，ASCOT-CHINA、TRISS存活误判率较AIS 1998低，AIS 2005对生存组、死亡组生存概率预测优于AIS 1998。结论 以AIS 2005为基础的ISS、TRISS、ASCOT等方法评价创伤及其结局预测总体上优于AIS 1998；建议使用AIS 2005评价多发伤时，以ISS〉20界定为严重多发伤可能更为合理。Objective To compare the superiority of AIS 2005 and AIS 1998 for evaluation of injury severity aud major trauma outcome. Methods 3 110 trauma patients evaluated by AIS 2005 and AIS 1998 from January 2003 to May 2005 were analyzed retrospectively. Results The mortality and morbidity of complications in trauma patients were ascending with the increase of ISS. The ascending tendency in mortality was more notable in ISS 〉 20 in AIS 2005. The mortality in trauma patients in AIS 2005 was significantly lower than those in AIS 1998 in ISS 〉 15-≤20（ P =0.001 ）. The morbidity of complications in trauma patients in AIS 2005 was significantly lower than those in AIS 1998 in ISS ≤15, the ascending tendency to morbidity of complications was more notable in other ISS groups in AIS 2005 than those in AIS 1998. RTS,TRISS,ASCOT and ASCOT-CHINA decreased with ISS ascending gradually,and the distribution of survival probability predictive value in AIS 2005 was more sensitive than those in AIS 2005. The distinctiveness and sensitivity of predictability index in AIS 2005 was higher than those in AIS 1998,and the degree of accuracy of the ASCOT and TRISS and the specificity of the ASCOT-CHINA and TRISS in AIS 2005 were higher than those in AIS 1998,and the survival miscarriage of justice ratio of the ASCOT-CHINA and TRISS in AIS 2005 was lower than that in AIS 1998, but the degree of accuracy of the ASCOT-CHINA and the specificity of the ASCOT in AIS 2005 were lower than those in AIS 1998,and the survival miscarriage of justice ratio of the ASCOT was higher than those in AIS 1998. There was superiority in AIS 2005 to the survival possibility prediction for survival and death group than in AIS 1998. Conclusion It is better by using the methods of ISS,TRISS, ASCOT to evaluate injury severity and predict major trauma outcome based on AIS 2005 than using AIS 1998. It is reasonable to definite severe trauma by ISS value greater than 20 in AIS 2005.

关 键 词：创伤评分 多发伤 损伤严重度评分 创伤结局 

分 类 号：R64[医药卫生—外科学]