胸部创伤严重度评价与救治结局探讨  

Exploration of the relationship between major trauma outcome and injury severity score in patients with chest trauma

作　　者：赵兴吉[1] 都定元[1] 孔令文[1] 苏泓洁[1] 张为民[1] 谭远康[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,400014

出　　处：《中华创伤杂志》2007年第3期215-218,共4页Chinese Journal of Trauma

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资助项目（01-1-005）

摘　　要：目的探讨以简明损伤定级标准（AIS）为基础的ISS与胸部创伤救治结局的关系。方法采用AIS-98最新修订本对我院1995年1月-2005年6月救治的3057例胸部创伤病例资料进行回顾性分析。结果总治愈率93．8％（2866／3057），病死率6．2％（191／3057）。死亡组ISS、GCS、修正创伤评分（RTS）、国人创伤严重度特征评分[ASCOT_CHINA]_生存概率（Ps）、创伤与损伤严重度评分（TRISS）_Ps、ASCOT_Ps与生存组比较，差异具有统计学意义（P〈0．01）。穿透伤病死率11．4％（75／655），显著高于钝性伤4．8％（116／2402）（P〈0．01），穿透伤组ISS值显著高于钝性伤组，但穿透伤组TRISS_Ps、ASCOT_Ps和ASCOT_CHINA_Ps明显低于钝性伤组。ISS值越高，RTS值越低，ASCOT_CHINA_Ps越低，病死率越高。ISSt〉20，病死率高达7．2％-28．8％；RTS≤6，病死率高达52．7％以上。TRISS和ASCOT准确性、特异性高，生存误判低，而ASCOT-CHINA灵敏度高，死亡误判低。结论以AIS-98为基础的ISS、TRISS、ASCOT、ASCOT_CHINA_Ps等方法评价胸部创伤或胸伤合并多发伤的严重度及其结局预测是可行的，TRISS、ASCOT和ASCOT_CHINA_Ps的各项预测性指标以及误判性指标趋于合理。Objective To explore the relationship of injury severity score based on AIS-98 with major trauma outcome in patients with chest trauma. Methods A total of 3 057 patients with chest trauma from January 1995 to June 2005 were retrospectively analyzed. Results Of the 3 057 patients, the overall survival rate and the mortality were 93.8% （2866/3057） and 6.2% （ 191/3057 ） respectively. Statistical differences in ISS, GCS, RTS, RTS-Ps, TRISS-Ps, ASCOT-Ps and ASCOT-CHINA-Ps were also found between the death group and the survival group （ P 〈 0.01 ）. The mortality in patients with penetrating chest trauma was significantly higher than that in those with blunt chest trauma[ 11.4% （75/ 655 ） vs 4.8% （ 116/2402 ） ] （ P 〈 0.01 ）, and ISS value of the penetrating chest injury group was significantly higher than that in the blunt chest trauma group, and TRISS-Ps,ASCOT-Ps and ASCOT-CHINA-Ps in the penetrating chest injury group were significantly lower than those in the blunt chest trauma group. The higher ISS value begot lower RTS and ASCOT-CHINA-Ps as well as higher mortality. The mortality was about 7.2% to 28.8% with an ISS≥20 and over 52.7% with an RTS≤6 in chest trauma patients. The degree of the accuracy and specificity were higher, but the survival miscarriage was lower in TRISS and ASCOT than in ASCOT_CHINA, on the contrary, the sensitivity was higher but the dead miscarriage was lower in ASCOT_CHINA than in TRISS and ASCOT. Conclusion It is feasible to predict severity and outcome of chest trauma or chest trauma complicated by multiple trauma by using ISS, TRISS, ASCOT and ASCOT CHINA_Ps based on AIS-98. It becomes reasonable for predictable and miscarriage of estimate indices inlcuding TRISS, ASCOT and ASCOT_CHINA_Ps.

关 键 词：创伤与损伤 胸部 多处创伤 损伤严重度评分 严重创伤结局 

分 类 号：R686[医药卫生—骨科学]