修正胸部穿透伤生理评分的初步探讨  

The Primary Study of Revising Physiological Score on Penetrating Thoracic Trauma

作　　者：万亚红[1] 石应康[1] 杨建[1] 武忠[1] 方强[1] 

机构地区：[1]华西医科大学附属第一医院胸心外科,成都610041

出　　处：《中国胸心血管外科临床杂志》2001年第3期182-185,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：卫生部科学研究基金资助 ( 98-1-2 2 7&&

摘　　要：目的　探讨胸部穿透伤 (PTT)创伤评分预测生死结局的效果 ,修正生理评分方法。　方法　将 2 95例PTT中 12 7例急诊手术患者分为生存组和死亡组进行多种创伤评分 ,比较两组在各种创伤评分间的差别 ,分析各种评分指标预测生死和实际生死结果。比较两组入院时、麻醉时伤后时间和各种生理参数的差别 ,结合实际生死用L ogistic回归分析计算各相关因素的权重 ,命名新指标为穿透伤进程评分 (PICS) ,比较并评价 PICS和修正创伤评分(RTS)。　结果　解剖评分的胸 AIS和损伤严重度评估 (ISS)在生存组和死亡组间差别具有显著性意义 (P<0 .0 5 ) ,而生理评分 RTS在预测生死结局的敏感性时并不令人满意。按入院和手术麻醉时生理参数的变化 ,选择格拉斯哥指数 (GCS)、伤后时间 (T)、脉压 (PP)、动脉收缩压 (SBP)作为 PICS的参数 ,经 L ogistic回归分析得到 PICS权重和计算公式 ;PICS和 RTS比较 ,其预测生死结局的准确性、敏感性提高 ,特异性不变 ,死亡误判率降低。　结论　建议在急诊评价穿透伤时可试用 PICS取代 RTS作为生理评分 。Objective To study the effects of trauma scores in the prognostic survivals and deaths for the patients with penetrating thoracic trauma(PTT), method of trauma score was revised. Methods One hundred and twenty seven emergency operating patients with PTT were divided into survival group and death group. Those patients were assessed by trauma scores. Various trauma scores were compared between the two groups. The prognostic survivals and deaths were compared with those of actual outcome. Various post trauma time and physiological parameters before anesthesia or on admission were compared between the two groups. Combining with the actual survivals and deaths, weight coefficients of correlate factors were calculated through Logistic regression. Penetrating injury course score (PICS) were named as a new index . PICS and revised trauma scale (RTS) were estimated . Results Anatomical score abbreviated injury scale (AIS), injury severity score (ISS) showed significant difference between the two groups. Physiological score RTS did not show significant difference between the two groups and hadn't produced excellent sensitivity in the prognosis of survivals and deaths . According to change of physiological parameters before anesthesia or on admission, the Glasgow Coma Scale(GCS), post trauma time (T),pulse pressure(PP),systole blood pressure(SBP) were defined as parameters of PICS. Through Logistic regression, weight coefficients and calculated formula of PICS were received, compared with RTS, outcome predictions of PICS revealed improvement in accuracy, sensitivity ,no difference in specificity and lower in erroneous judgement for deaths. Conclusion The results suggest that RTS is replaced by PICS in physiological score for emergency patients of penetrating injury .Rationality of PICS for clinical use would be observed again.

关 键 词：胸部穿透伤 修理创伤评分 穿透伤进程评分 

分 类 号：R655[医药卫生—外科学]