NISS对多发伤休克患者应激性溃疡的预测价值  

Predictive Value of New Injury Severity Score in Stress Ulcer of Shock Patients with Multiple Trauma

作　　者：罗小敏[1] 殷惠美 LUO Xiaomin et al(Renmin Hospital of Wuhan University, Hubei Wuhan 430060, Chin)

机构地区：[1]武汉大学人民医院急诊科,湖北武汉430060 [2]新疆维吾尔自治区博州人民医院重症医学科,新疆博乐833400

出　　处：《河北医学》2017年第8期1326-1329,共4页Hebei Medicine

摘　　要：目的:探讨NISS(new injury severity score)对于多发伤休克患者应激性溃疡的预测价值。方法:回顾性分析2015年8月至2016年9月在重症医学科住院治疗的92例多发伤休克患者的临床资料,根据是否并发应激性溃疡将患者分为溃疡组20例和非溃疡组72例,比较两组在性别、年龄构成、休克程度、糖皮质激素应用、机械通气、手术治疗、NISS、ISS和APACHEⅡ评分各方面的差异,对相关因素进行logistic回归分析,对独立危险因素进行ROC曲线分析其对应激性溃疡的预测价值。结果:两组患者在性别、年龄构成、糖皮质激素应用和手术治疗比例各方面差异无统计学意义(P>0.05),而在休克程度和机械通气比例方面差异具有统计学意义(P<0.05)。溃疡组患者NISS、ISS和APACHEⅡ评分分别为29.00±5.26、26.25±5.48和18.10±4.29,非溃疡组分别为23.32±4.04、21.72±3.74和15.42±3.73,溃疡组3项评分均分别高于非溃疡组,差异具有统计学意义(P<0.01)。Logistic回归分析显示仅NISS评分是应激性溃疡的独立危险因素。NISS预测应激性溃疡的ROC曲线下面积为0.825,其最佳截断值为26.5,对应敏感度、特异度、阳性预测值和阴性预测值分别为85.0%、77.8%、51.5%和94.9%。结论:NISS是多发伤休克患者发生应激性溃疡的独立危险因素,预测应激性溃疡具有较高的准确性。Objective： To explore the predictive value of new injury severity score（ NISS） in stress ulcer of shock patients with multiple trauma. Methods： Clinical data of 92 ICU shock patients suffered from multiple trauma were retrospectively reviewed between August 2015 and September 2016. The patients were divided into two groups with either stress ulcer present（ 20 cases） or absent（ 72 cases）. Some clinical characteristics were compared between two groups. Multivariate logistic regression and receiver operating characteristic curve（ ROC） were performed to identify independent risk factors of stress ulcer and the predictive accuracy. Results： The difference in shock degree and mechanical ventilation were statistically significant between two groups（ P〈0.05）,while that in gender,age,ratio of glucocorticoid usage or operative treatment between two groups didn＇t reach significant level（ P〉0.05）. The scores of NISS,ISS and APACHE Ⅱ were obviously higher in the stress ulcer group than non-stress ulcer group（ 29.00±5.26 vs.23.32±4.04,26.25±5.48 vs.21.72±3.74 and 18.10±4.29 vs.15.42±3.73,respectively,P〈0.05 for all）. Multivariate logistic regression analysis showed that only NISS was correlated with the incidence of stress ulcer. The area under the cure for NISS was 0.825 by ROC analysis. The best boundary value of NISS was 26.5 with the sensitivity,specificity,positive predictive and negative predictive values of 85. 0%,77. 8%,51. 5% and 94. 9%,respectively. Conclusions： NISS is an independent risk factor for stress ulcer in shock patients suffered from multiple trauma. NISS can predict stress ulcer with a good accuracy in this population.

关 键 词：多发伤 休克 应激性溃疡 新损伤严重度评分 

分 类 号：R605.971[医药卫生—急诊医学]