中重度蛇咬伤患者预后影响因素分析  

Analysis of Prognostic Factors in Patients with Moderate to Severe Snakebite

作　　者：田飞 张蓉[1] 刘静兰[1] 张朝晖[1] 周法庭[1] 席祖洋[1] 雷云宏[1] 杨路焕 郭庆[1] 桂升敏 Tian Fei;Zhang Rong;Liu Jinglan;Zhang Zhaohui;Zhou Fating;Xi Zuyang;Lei Yunhong;Yang Luhuan;Guo Qing;Gui Shengmin(Department of Emergency and Critical Care Medicine,Yichang Central People's Hospital,The First College of Clinical Medical Science,China Three Gorges University,Yichang 443003,China;Department of Critical Care,Yichang First People's Hospital,People's Hospital,China Three Gorges University,Yichang 443000,China)

机构地区：[1]三峡大学第一临床医学院[宜昌市中心人民医院]急危重症医学科,湖北宜昌443003 [2]三峡大学人民医院[宜昌市第一人民医院]重症医学科,湖北宜昌443000

出　　处：《巴楚医学》2020年第3期49-54,64,共7页Bachu Medical Journal

基　　金：宜昌市医疗卫生科研项目(No:A19-301-02)。

摘　　要：目的:分析中重度蛇咬伤患者治疗效果的影响因素,为临床蛇咬伤患者的病情评估和预后判断提供参考。方法:分析我院急诊科2019年1月~12月收治的127例中重度蛇咬伤患者,根据伤口切排方式分组比较患者临床特征,采用Logistic回归进行影响因素分析,并绘制ROC曲线评价模型,然后构建列线图预测模型。结果:两组蛇咬伤患者的临床资料无统计学差异(均P>0.05)。Logistic回归分析结果显示,就诊时间、伤口切排方式、蛇咬伤严重程度、凝血功能受损程度是中重度蛇咬伤预后的独立影响因素。上述因素联合诊断显示有较高的诊断预测价值(AUC=0.798,P<0.001)。继而构建多因素列线图模型,其C-index为0.740,内部校正C-index为0.711,可以较好的实现个体化预测。结论:就诊时间、伤口切排方式、蛇咬伤严重程度、凝血功能受损程度是中重度蛇咬伤痊愈的独立影响因素,基于以上因素建立的个体化预测模型对中重度蛇咬伤患者临床治疗具有一定指导意义。Objective:To analyze the influencing factors for treatment effect of moderate to severe snakebite patients,and provide reference for disease evaluation and prognosis judgment in snakebite patients.Methods:Regression analysis was performed on 127 patients with moderate to severe snakebite in our hospital from January to December 2019.Clinical characteristics were compared between patients with different wound incision.Logistic regression was used to analyze the influencing factors.ROC curve evaluation model was drawn,followed with a nomogram prediction model.Results:There was no statistical difference in clinical features between the two groups(all P>0.05).The logistic regression analysis suggested that the time of visiting the doctor,the way of wound incision and discharge,the severity of snakebite,and the degree of impaired coagulation function were independent influence factors for prognosis of moderate and severe snakebite.The combined diagnosis on basis of these factors mentioned above has a highly diagnostic predictive value(AUC=0.798,P<0.001).Then,the multi-factor nomogram model is constructed,whose C-index is 0.740 and internal correction C-index is 0.711,which can better realize individual prediction.Conclusion:The time of visiting the doctor,the way of wound incision and discharge,the severity of snakebite and the degree of blood coagulation damage are independent influencing factors for the recovery of moderate to severe snakebite.The individual prediction model based on the factors mentioned above has certain guiding significance for treatment of moderate to severe snakebite patients.

关 键 词：蛇咬伤 LOGISTIC回归分析 列线图 

分 类 号：R595.4[医药卫生—内科学]