Marshall CT分级联合Fisher CT分级在颅脑创伤患者预后评估中的应用  

The prognostic value of Marshall CT classification combined with Fisher CT cassification in patients with traumatic brain injury

作　　者：黄欣[1] 温良[1] 王浩[1] 王芳[1] 龚江标[1] 郑秀珏[1] 

机构地区：[1]浙江大学医学院附属第一医院,杭州310003

出　　处：《浙江创伤外科》2016年第5期816-819,共4页Zhejiang Journal of Traumatic Surgery

基　　金：浙江省教育厅项目(Y201223992)

摘　　要：目的 评估Marshall CT分级联合Fisher CT分级在评估颅脑创伤患者预后中的应用价值。方法前瞻性收集并分析本院2013年1月至2015年6月本院初诊收治的179例颅脑创伤患者的病例资料,将患者的Marshall CT分级和Fisher CT分级相加得到总CT评分,评价并比较其在评估患者预后中的应用价值。结果 相关分析表明,GCS评分与患者预后的相关系数为0.795,Marshall CT分级与患者预后的相关系数为-0.718,总CT评分与患者预后的相关系数为-0.751。3种参数与患者预后均有显著相关性（P〈0.01）,且相对来讲,Marshall CT分级联合Fisher CT分级的总CT评分与患者预后具有更强的相关性。受试者工作特征曲线（Receiver Operating Characteristic,ROC曲线）结果显示,Marshall CT分级的曲线下面积为0.885（P〈0.01,95%CI 0.751~1.000）,总CT评分的曲线下面积为0.897（P〈0.01,95%CI 0.767~1.000）。相比较而言,总CT在评估患者预后方面略有优势。以总CT评分≥7作为判定患者预后不良的临界值,其敏感性为100%,特异性69.2%,约登指数为0.692,具有较好的预后判断价值。结论 Marshall CT分级联合Fisher CT分级在评估颅脑创伤患者预后方面有较好的应用价值。Objective To evaluate the prognostic value of Marshall CT classification combined with Fisher CT classification in patients with traumatic brain injury （TBI）. Methods We prospectively collected the clinical information of 179 TBI patients from January, 2013 to June, 2015 and defined Total CT Score as Marshall CT classification plus Fisher CT classification. Then we studied the effect of Total CT Score in evaluating the prognosis of patients with TBI. Results We found that the correlation coefficient of GCS with patients＂ outcomes （defined by Glascow Outcome Score） was 0.795 （P〈0.01）, which was -0.718 （P〈0.01） and -0.751 （P〈0.01） respectively of Marshall CT classification and Total CT Score with the outcomes. The analysis of Receiver Operating Characteristic curve （ROC curve） indicated that the area under the curve （AUC） of Marshall CT classification was 0.885 （P〈0.01,95%CI 0.751-1.000）and the AUC of Total CT Score was 0.897 （P〈0.01,95%CI 0.767-1.000）. The value of Total CT Score is better than Marshall CT classification. Given Total CT Score 7 to be the cut-off point, the sensitivity of unfavourable outcomes was 100%, the specificity was 69.2% and the Youden Index was 0.692. Conclusion We concluded that it has a good prognostic value of Marshall CT classification combined with Fisher CT classification in patients with TBI.

关 键 词：颅脑创伤 预后 Marshall CT分级 FISHER CT分级 

分 类 号：R651.1[医药卫生—外科学]