MEWS、APACHEⅡ、NISS与血栓弹力图在急诊多发伤对伤情评价和预后价值  

The value of MEWS, APACHEII, NISS and thromboelastogram in the evaluation of injury and prognosis of multiple inuries in emergency department

作　　者：杨保刚[1] 杨夏玲[1] YANG Baogang;YANG Xialing(Taizhou Hospital of Zhejiang Province,Zhejiang 317000,China)

机构地区：[1]浙江省台州医院,台州317000

出　　处：《浙江创伤外科》2021年第1期14-16,共3页Zhejiang Journal of Traumatic Surgery

摘　　要：目的探讨改良早期预警评分(MEWS)、急性生理学及慢性健康状况评分(APACHEⅡ)、新损伤严重程度评分(NISS)与血栓弹力图在急诊多发伤患者伤情评价和预后预测价值。方法选取2018年1月至2019年12月在本院接诊的156例多发伤患者,按生存状态分为存活组(n=130)和死亡组(n=26)。记录患者性别、年龄、致伤原因等一般资料。比较两组MEWS、APACHE-Ⅱ、NISS评分与血栓弹力图伤情情况。结果治疗后,存活组MEWS、APACHE-Ⅱ、NISS、血栓弹力图中的K均低于死亡组,存活组α角、MA、CI、G、E、CLT均高于死亡组,差异均有统计学意义(P<0.05)。MEWS、APACHE-Ⅱ、NISS评分与血栓弹力图对存活组多发伤患者评分准确率分别为76.92%、94.62%、80.77%、78.46%,显著高于死亡组,有统计学意义(P<0.05)。NEWS对多发伤患者预后敏感度为81.3%,特异度为55.6%;APACHE-Ⅱ敏感度为62.5%,特异度为81.5%;NISS敏感度为59.4%,特异度为78.8%;血栓弹力图敏感度为53.1%,特异度为96.3%。结论 NEWS、APACHE-Ⅱ、NISS与血栓弹力图对急诊多发伤患者病情评价均有良好的预测价值,可作为急诊多发伤患者伤情评价和预后评估的方法。其中APACHEⅡ预测价值最大,且更适合已留院观察的多发伤患者。Objective To invesitgate the value of modified early warning score(MEWS),acute physiology and chronic health score(APACHE-Ⅱ),new injury severity score(NISS)and thromboelastogram in the evaluation of injury and prognosis of multiple inuries in emergency department.Methods Total of 156 patients with multiple injuries who were admitted to the emergency department in our hospital from January2018 to December 2019 were included.All patients were divided into the survival(n=130)and the death groups(n=26)according to survival status.The general information such as the cause of injury,the patient’s gender and age were recorded.All patients with multiple injuries were evaluated and compared with MEWS,APACHE-Ⅱ,NISS and thromboelastogram.The receiver operating characteristic curve(ROC)was used to evaluate the prognostic value of MEWS,APACHE-Ⅱ,NISS and thromboelastogram for multiple injuries.Results After treatment,MEWS,APACHE-Ⅱ,NISS,Kin the thromboelastogram of the survival group were lower than those of the death group,and theαangle,MA,G,CI,E,and CLT of the survival group were all higher than those of the death group,the difference were all statistically significant(P<0.05).The accuracy rates of MEWS,APACHE-Ⅱ,NISS scores and thromboelastogram of patients with multiple injuries in the survival group were 76.92%,94.62%,80.77%respectively,and78.46%,30.78%,69.23%in the death group,the differences were all statistically significant(P<0.05).The area under curve(AUC)of the prognostic value of NEWS for patients with multiple injuries was 0.701(95%CI 0.565-0.837).When the optimal cutoff value was 0.369,the sensitivity was81.3%and the specificity was 55.6%.The AUC of the prognostic value of APACHE-Ⅱfor patients with multiple injuries was 0.796(95%CI0.685-0.908).When the optimal cutoff value was 0.440,the sensitivity was 62.5%and the specificity was 81.5%.The AUC of the prognostic value of NISS for patients with multiple injuries was 0.726(95%CI 0.598-0.853).When the optimal cutoff value was 0.372,the sensitivity was 5

关 键 词：多发伤 改良早期预警评分 急性生理学及慢性健康状况评分 新损伤严重程度评分 血栓弹力图 

分 类 号：R459.7[医药卫生—急诊医学]