机械性创伤患者血栓形成的预警评分体系的构建研究  

Construction of an Early Warning Scoring System for Thrombosis in Patients with Mechanical Trauma

作　　者：展秀君 沈忠达 沈萍[1] 张俊玮 吴媛媛[1] ZHAN Xiujun;SHEN Zhongda;SHEN Ping;ZHANG Junwei;WU Yuanyuan(Jiamusi Hospital of Traditional Chinese Medicine,Jiamusi 154002,China;不详)

机构地区：[1]黑龙江省佳木斯市中医院,黑龙江佳木斯154002

出　　处：《中国医学创新》2021年第8期150-154,共5页Medical Innovation of China

摘　　要：目的:建立一种纳入特异性生长因子(specific growth factor,SGF)、血小板(PLT)、凝血、抗凝及纤溶系统情况的机械性创伤患者血栓形成的新预警评分体系。方法:选取2017年3月-2018年2月本院收治的机械性创伤患者591例的临床资料进行回顾性分析。按有无血栓形成将其分为血栓组(n=382)和非血栓组(n=209)。比较两组性别、年龄、临床资料特征、相关危重症评分、血培养结果及实验室生化检查情况。采用多因素logistic回归分析,筛选机械性创伤患者形成血栓的危险因素,并予以赋值,其总分即为血栓形成预警评分。评价血栓形成预警评分对机械性创伤患者并发血栓的预测价值。结果:血栓组抗凝血酶Ⅲ(ATⅢ:Ag)>335 mg/L、活化部分凝血活酶时间(APTT)>35 s、D-二聚体(DD)>19 mg/L、纤维蛋白降解物(FDP)>14.5μg/mL、SGF>73.5 U/mL、损伤严重度评分(ISS)>25分及急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)≥21分例数均高于非血栓组(P<0.05)。多因素logistic回归分析结果显示,ATⅢ:Ag>335 mg/L、APTT>35 s、DD>19 mg/L、FDP>14.5μg/mL、SGF>73.5 U/mL、ISS>25分和APACHEⅡ≥21分为机械性创伤患者血栓形成的危险因素(P<0.05),将上述影响因素作为形成血栓预警评分建立的基础,予以赋值,其总分为预警评分。非血栓组的平均预警评分为(2.04±0.99)分低于血栓组(4.12±1.17)分(P<0.05)。血栓形成预警评分预测创伤患者形成血栓的AUC为0.825,明显高于APACHEⅡ、APTT、DD和FDP,当血栓形成预警评分的截断值为2.50分时,敏感度为71.35%,特异度为89.11%,约登指数为0.605。结论:机械性创伤患者血栓形成预警评分体系由ATⅢ:Ag、APTT、DD、FDP、SGF、ISS及APACHEⅡ组成,合理运用此预警评分体系可以更加直接有效地评估创伤患者预后,其预测效果远高于单独应用APTT、DD、FDP及APACHEⅡ评分。Objective:To establish a new early warning scoring system for thrombosis in patients with mechanical trauma including specific growth factor(SGF),platelet(PLT),coagulation,anticoagulation and fibrinolytic systems.Method:Clinical data of 591 patients with mechanical trauma admitted to our hospital from March 2017 to February 2018 were retrospectively analyzed.According to whether thrombosis or not,they were divided into thrombosis group(n=382)and non-thrombosis group(n=209).The gender,age,clinical data characteristics,related critical illness scores,blood culture results and laboratory biochemical tests were compared between the two groups.Multivariate logistic regression analysis was used to screen the risk factors of thrombosis in mechanical trauma patients and assign the value.The total score was assigned as the early warning score of thrombosis.The predictive value of thrombosis early warning score in patients with mechanical trauma complicated with thrombosis was evaluated.Result:The number of ATⅢ:Ag>335 mg/L,APTT>35 s,DD>19 mg/L,FDP>14.5μg/mL,SGF>73.5 U/mL,ISS>25 scores and APACHEⅡ≥21 scores cases in the thrombosis group were higher than those in the non-thrombosis group(P<0.05).Multiariable logistic regression analysis results showed that the ATⅢ:Ag>335 mg/L,APTT>35 s,DD>19 mg/L,FDP>14.5μg/mL,SGF>73.5 U/mL,ISS>25 scores and APACHEⅡ≥21 scores were risk factors for thrombosis in patients with mechanical trauma(P<0.05).The above factors were taken as the basis for establishing the thrombosis early warning score and assigned the value.The total score was assigned as the early warning score.The mean warning score of the non-thrombosis group was(2.04±0.99)scores was lower than(4.12±1.17)scores of the thrombosis group(P<0.05).The AUC of thrombosis early warning score was 0.825 significantly higher than APACHEⅡ,APTT,DD and FDP,when the cutoff value of thrombosis early warning score of 2.50 scores,the sensitivity was 71.35%,the specificity was 89.11%and the Youden index was 0.605.Conclusion:Mechani

关 键 词：机械性创伤 血栓 预警评分体系 ISS评分 APACHEⅡ评分 

分 类 号：R641[医药卫生—外科学]