呼吸功能不全和死亡率预测评分的建立与验证：简单床边附加评分预测急性颈椎损伤患者的机械通气和住院死亡率  

作　　者：Padmaja Durga Barada Prasad Sahu Srinivas Mantha Gopinath Ramachandran 周洁(译) 李士通(校) 

机构地区：[1]Departments of Anesthesiology and Intensive care [2]Departments ofNeurosurgery,Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India [3]不详

出　　处：《麻醉与镇痛》2012年第4期64-70,共7页Anesthesia & Analgesia

摘　　要：背景很多研究都建立了“严重性评分”或“风险指数”来评估机械通气和死亡率，但用来预测颈椎损伤（cervicalspinelinjury，CSI）患者的预后方法却很少。因此我们的研究目的是建立一种简单床边附加评分对CSI患者的机械通气和早期住院死亡率进行评估。方法对101例已行手术治疗的外伤性CSI患者（建立组）数据进行了多变量回归分析，以确定可预测机械通气必要性和早期院内死亡率的独立预测因子。利用计算回归系数，分别为机械通气和住院死亡率建立呼吸功能不全及死亡率的预测因子（predictorsofrespiratoryinsufficiencyandmortality，PRIM）。使用受试者工作特性曲线比较预期和实测结果，来检测该预测模型的准确性。并在连续收住的87例外伤性急性CSI患者（验证组）中进行验证。结果建立组中有16．8％的患者使用了机械通气，住院死亡率为17．8％。机械通气的独立风险因子是重度损伤（美国脊柱损伤协会损伤程度分级A级和B级）、憋气时间、肺部感染、血流动力学不稳定和进行性神经系统损害。这些变量分别对应的分数为15、20、25、25和15。死亡的独立预测因子是重度损伤（美国脊柱损伤协会损伤程度分级A级和B级）、血流动力学不稳定、进行性神经系统损害和机械通气。这些变量分别对应的分数为20、20、40和20。机械通气和死亡率的PRM评分有极好的分辨力（接受者操作特征曲线下面积〉0．75）。建立组和验证组的预测和实测结果均有较好的相关性。结论PR蹦评分可以准确预测急性CSI患者使用机械通气的风险以及住院死亡率。BACKGROUND： Numerous studies have developed a ＂severity score＂ or ＂risk index＂ for mechanical ventilation and mortality, but there are few to predict outcomes for cervical spine injury （CSI） patients. Our objective in this study was to develop a simple bedside additive predictive score for requirement for ventilation and early in-hospital mortality for patients with CSI. METHODS： Multivariate logistic regression analysis of the data obtained from 101 patients （development set） after surgical stabilization of traumatic CSI was performed to identify independent predictors of the need for mechanical ventilation and of early in-hospital mortality. Predictors of respiratory insufficiency and mortality （PRIM） scores were developed separately for ventilation and mortality by using the coefficients of the logistic regression model. The model was validated using the receiver operating characteristics curve to test its discriminatory ability and by comparing the predicted and observed outcomes. Validation. was performed on an independent data set of 87 consecutive patients （validation set） with traumatic acute CSI. RESULTS： Mechanical ventilation was required in 16. 8% of the patients, and the in-hospital mortality rate was 17. 8% in the development set. Independent risk factors for mechanical ventilation were severe injury （American Spinal Injury Association Impairment Scale Grades A and B）, breath-holding time, pulmonary infection, hemodynamic instability, and progressive neurologic deterioration. Scores of 15, 20, 25, 25, and 15 were assigned to these variables, respectively. Independent predictors of death were severe injury （American Spinal Iniury Association Impairment Scale Grades A and B ）, hemodynamic instability, progressive neurologic deterioration, and mechanical ventilation. The scores assigned for each of the variables were 20, 20, 40, and 20, respectively. The PRIM scores for mechanical ventilation and mortality had excellent discrimination （area under receiver operati

关 键 词：住院死亡率 呼吸功能不全 预测评分 机械通气 颈椎损伤 伤患者 气和 急性 

分 类 号：R735.8[医药卫生—肿瘤]