应用ISS和NISS评估伴严重胸部损伤的多发伤患者并发症与救治结局  

Injury severity score and new injury severity score for assessing the complications and treatment outcomes in multiple trauma patients combined with severe chest trauma

作　　者：孔令文[1] 卢仁福[1] 谭远康[1] 苏泓洁[1] 张为民[1] 赵兴吉[1] 都定元[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》2012年第7期580-583,共4页Chinese Journal of Trauma

基　　金：重庆市科委自然科学基金重点资助项目（CSTC2012jjBl0021）;重庆市卫生局医学科学技术研究重点资助项目（2010-1-52）

摘　　要：目的探讨新的损伤严重度评分（new injury severity score, NISS）和ISS在评估伴严重胸部损伤的多发伤患者的并发症与救治结局中的应用价值。方法采用简明损伤评分-2005（AIS-2005）对重庆市急救医疗中心2005年1月-2011年1月救治的1377例伴严重胸部损伤的多发伤患者资料（胸部AIS≥3分）进行回顾性分析。计算NISS和ISS，并分析其与死亡的相关性。结果治愈率为93．2％，死亡率为6．8％，并发症发生率为28．5％。NISS值（r=0．569，P〈0．01）、ISS值（r=0．442，P〈0．01）分别与并发症发生率呈正相关，NISS值（r=0．693，P〈0．01）、ISS值分别与死亡率呈正相关（r=0．774，P〈0．01），其中NISS值与并发症发生率、ISS值与死亡率有更强的相关性。在并发症发生预测方面，NISS敏感性优于ISS，特异性不及ISS（P〈0．01），在死亡预测方面，ISS与NISS相当（P〉0．05）。结论NISS和ISS均能较好评价伴严重胸部损伤的多发伤患者的并发症与救治结局。利用NISS值预测并发症的发生，ISS值预测救治结局以尽可能提高预测的准确性。Objective To investigate the role of ISS and new injury severity score （NISS） in e- valuation of complications and treatment outcomes in the multiple trauma patients combined with severe chest trauma. Methods AIS-2005 was used to carry out retrospective analysis of the 1 377 multiple trauma patients combined with severe chest trauma （thoracic AIS ≥ 3 points） treated at Chongqing Emer- gency Medical Center from January 2005 to January 2011. In the meantime, the related NISS and ISS were calculated and their relations with mortality were analyzed. Results The overall healing, mortali- ty and complication rate were 93.2%, 6.8% and 28.5% respectively. Both the ISSN and ISS had posi- tive correlation with morbidity of complications （ r = 0. 569, P 〈 0.01 ; r = 0. 442, P 〈 0.01 ） and mortality （ r = 0. 693, P 〈 0.01 ; r = 0. 774,P 〈 0.01 ）, but a stronger relevance was demonstrated between NISS and morbidity of complications and between ISS and mortality rate. NISS showed a higher sensitivity but less specificity than ISS in prediction of morbidity of complications （P 〈 0.01 ）, and NISS was not superi- or to ISS in prediction of mortality （P 〉 0.05）. Conclusions Both NISS and ISS work well in evalua- ting the complications and treatment outcomes in multiple trauma patients combined with severe chest trauma. Thus, NISS should be applied for prediction of complication occurrence and ISS for treatment out- comes to maximize the prediction accuracy.

关 键 词：多处创伤 胸部损伤 损伤严重度评分 结果评价 

分 类 号：R655[医药卫生—外科学]