AIS-ISS评分对多发伤合并脑外伤患者预后评估价值  

Prognostic value of AIS-ISS on multiple injury patients with head injury

作　　者：贾圣洁 包龙[1] Jia Shenglie;Bao Long(The First Affiliated Hospital of Suzhou University,Suzhou 215006)

机构地区：[1]苏州大学附属第一医院急诊外科,江苏苏州215006

出　　处：《中国现代医药杂志》2018年第9期10-13,共4页Modern Medicine Journal of China

摘　　要：目的研究创伤严重度评分(AIS-ISS)对多发伤合并脑外伤患者预后的评估作用。方法收集从2010年11月~2017年10月入住我院创伤病房及ICU的合并脑外伤的多发伤患者共计354例,通过院内信息系统获得临床数据。电话随访脑外伤后6个月的格拉斯哥预后评分(GOS),并分为恢复良好组(GOS评分为4~5分)及恢复不良组(GOS评分为1~3分),运用Logistic回归、ROC曲线、Spearman分析等方法进行数据分析。结果患者的ISS评分随GOS评分下降而逐渐升高。Logistic回归分析中:单变量和多变量分析均提示ISS评分与患者恢复不良相关(P<0.01)。多变量Logistic回归提示AIS-头部、AIS-胸部与患者恢复不良有关。ROC曲线分析得到ISS的曲线下面积为0.853。Spearman方法分析所有患者,结果 ISS与GOS评分之间呈显著负相关,r=-0.603。以GCS值5分作为分界,将患者分为高低两组再进行Spearman分析,提示高分组中ISS与GOS相关性更大。结论多发伤合并脑外伤患者中,ISS是预后不良的独立危险因素,在GCS>5分的患者中作用较大。多发伤患者头部、胸部AIS分值也是预后不良的独立危险因素,头部AIS分值提示作用更大。Objective To investigate the prognostic value of abbreviated injury score （AIS） and injury severity score （ISS） in multiple injury patients with head injury. Methods A retrospective analysis of 354 patients admitted to the emergency department and intensive care unit were selected from Nov 2010 to Oct 2017. Got the Glasgow outcome scale （GOS） 6 months after brain injury by telephone. All the patients were divided into two groups, well-restored group （GOS=4-5） and poor-restored group （GOS=1~3）. Results ISS level had negative correlation with GOS level. In multivariate logistic regression model, the adjusted OR of ISS level was 1.096 （95%Ch 1.030-1.166, P〈0.01）. ROC curve analysis showed the AUC for ISS was 0.853 （95%CI：0.808-0.897）. The AIS components of ISS were also analyzed, multivariate logistic regression suggested that the head AIS and chest AIS were correlated with poor outcome（OR of head AIS was 1.708, 95%CI：1.154-2.526,P〈0.05 ; OR of chest AIS was 1.609, 95% CI： 1.073-2.412, P〈0.05）. The relevant analysis revealed a significant negative correlation between ISS and GOS （r=-0.603, P〈0.01）. Spearman analysis with grouped GCS （GCS≤5, GCS〉5） suggested that high GCS group （r=0.356, P〈0.05） ISS had a greater relation with GOS compared with low GCS group （r=0.247, P〈0.05）. Conclusion ISS level can be considered as an independent predictor of poor prognosis of multiple injury patients with head injury, especially better in patients whose GCS level are over 5. The head and chest AIS of ISS can also affect the prognosis of patients, the head AIS shows more importance.

关 键 词：多发伤 颅脑外伤 AIS ISS 预后评估 

分 类 号：R641[医药卫生—外科学]