院前急救中两种创伤评分法对急性酒精中毒合并外伤性颅内出血患者的评估作用  

Evaluation Value of Two Trauma Scaling Systems in Patients of Acute Alcoholism with Traumatic Intracranial Hemorrhage in Pre-hospital Care

作　　者：胡海[1] 杜鑫淼[2] 蒋臻[1] 许树耘[1] 曹钰[1] 

机构地区：[1]四川大学华西医院急诊科,四川成都610041 [2]四川大学华西医院呼吸科,四川成都610041

出　　处：《华西医学》2009年第8期1929-1931,共3页West China Medical Journal

摘　　要：目的:探讨使用院前指数(Prehospital Index,PHI)及格拉斯哥昏迷评分(Glasgow Coma Score,GCS)两种创伤评分法对院前急救中急性酒精中毒合并外伤性颅内出血患者的评估价值。方法:纳入68例院前急救中酒精中毒合并头外伤患者,院前均进行PHI及GCS两种创伤评分,随访至出院,以头部CT扫描及随访结果作为标准以判断患者是否伴有颅内出血。计算两种创伤评分的敏感度、特异度、阳性似然比、阴性似然比、阳性预测值、阴性预测值及Youden指数,并作出受试者工作特征曲线(ROC曲线),以正态离差值Z检验两种评分法ROC曲线下面积的差异。结果:院前指数以6分作为诊断界值,敏感度为94.7%,特异度为71.4%;格拉斯哥昏迷评分以9分作为诊断界值,敏感度为98.8%,特异度为30.6%,PHI及GCS的ROC曲线下面积分别是0.881和0.678,其差异有统计学意义。结论:在对急性酒精中毒合并头外伤患者是否伴有颅内出血的院前评估中,院前指数较格拉斯哥昏迷评分更有价值。Objective：To evaluate the value of PHI and GCS in patients with acute alcoholism combined traumatic intracranial hemorrhage in pre-hospital care.Methods：This study included 68 patients with acute alcoholism and head injuries.In pre-hospital care,PHI and GCS were measured for each patients.We calculated the sensitivity,the specificity,positive likelihood ratio,negative likelihood ratio,positive predictive value,negative predictive value and Youden s index.The best cutoff point in each scoring system was determined using the ROC curve. The difference in ROC was calculated using the Z score. Results： The cutoff point of PHI is 6 ,the Sensitivity is 94.7% and the Specific ity is 71.4%. The cutoff point of GCS is 9,the Sensitivity is 98.8% and the Specificity is 30.6%. There are statistical ly significant differences in the area under the ROC curve between PHI and GCS. Conclusion： PHI is more effective than GCS in patients with acute alcoholism and traumatic intracranial hemorrhage in pre-hospital care.

关 键 词：急性酒精中毒 外伤性颅内出血 院前指数 格拉斯哥昏迷评分 院前急救 

分 类 号：R595.6[医药卫生—内科学] R743.3[医药卫生—临床医学]