早期预测危重多发伤患者生存时间的指标分析  

Index Analysis on Early Prediction of Survival Time in Severe Multiple Trauma Patients

作　　者：吕林[1] 胡海[1] 曹钰[1] 

机构地区：[1]四川大学华西医院急诊科,成都610041

出　　处：《华西医学》2016年第10期1641-1644,共4页West China Medical Journal

基　　金：国家卫生和计划生育委员会公益性行业科研专项项目(201302003);四川省卫生和计划生育委员会科研课题(150169)~~

摘　　要：目的探索修正创伤评分(RTS)、严重创伤转归研究(MOTS)-RTS评分与床旁快速检测指标对危重多发伤患者生存时间的早期预测价值。方法纳入2015年9月-12月四川大学华西医院急诊科收治的危重多发伤患者,收集患者入院时的基本信息、生理指标(呼吸、血压和意识状态)和快速床旁生物化学检测指标,包括p H值、血红蛋白、碱剩余、红细胞比容、动脉乳酸、血钠、动脉及肺泡氧分压比、阴离子间隙、血糖等。计算每例患者的RTS和MOTS-RTS评分。按照患者创伤30 d的预后,将研究对象分为生存组与死亡组,通过Cox比例风险模型筛选出患者生存时间的风险指标。结果共纳入危重多发伤患者75例,其中男51例,女24例;死亡14例。多因素分析中Cox比例风险模型分析筛选出危重多发伤患者死亡风险指标包括MOTS-RTS评分[RR=0.726,95%CI(0.608,0.867),P<0.001]和床旁快速乳酸检测指标[RR=1.139,95%CI(1.010,1.324),P=0.037]。结论 MOTS-RTS联合乳酸可应用于危重多发伤患者生存时间的早期预测。Objective To study the value of revised trauma scores（RTS）,major trauma outcome study（MTOS）-RTS scores and point of care test（POCT） in the early forecast of survival time in severe multiple trauma patients.Methods Multiple trauma patients treated in the Emergency Department of our hospital between September and December 2015 were included in our study.We collected such data as the basic information on admission,physical signs（breath,blood pressure,state of consciousness） and POCT indexes,including pH value,hemoglobin,base excess,hematocrit value,lactic acid,sodium,anion gap,and blood glucose.We calculated each patient＇s RTS and MTOS-RTS scores.According to the 30-day prognosis,the patients were divided into survival group and death group.Risk factors for survival time were screened by Cox regression risk model.Results Seventy-five multiple trauma patients were included in our study.Among them,there were 51 males and 24 females.Fourteen of them died.The multivariate analysis in the Cox regression risk model showed that the risk factors for the death of multiple trauma patients included MOTS-RTS score[RR=0.726,95%CI（0.608,0.867）,P〈0.001） and POCT lactic acid level[RR=1.139,95%CI（1.010,1.324）,P=0.037].Conclusion MOTS-RTS combined with lactic acid level may be used in the early forecast of survival time in severe multiple trauma patients.

关 键 词：危重多发伤 床旁快速检测指标 生存时间 早期预测 

分 类 号：R641[医药卫生—外科学]