年龄校正rSIG指数预测急诊一二级创伤患者预后的价值  

The predictive value of age-adjusted rSIG in the prognosis of the first-level and second-level trauma patients

作　　者：刘丹 方熙 周浩[1] 李琳[1] 李华[1] 康健[1] Liu Dan;Fang Xi;Zhou Hao;Li Lin;Li Hua;Kang Jian(Department of Emergency,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院急诊科,江苏南京210029

出　　处：《中国急救医学》2022年第9期774-778,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的探寻年龄校正反向休克指数(reverse shock index,rSI)和格拉斯哥昏迷(Glasgow Coma Scale,GCS)评分的乘积,即rSIG指数,预测急诊一二级创伤患者预后的价值。方法回顾性分析我院2020年1月至2020年12月所有急诊一二级创伤患者的基本数据,共538例,其中男400例,女138例。根据住院期间是否死亡,分为存活组和死亡组,对比两组患者性别、年龄、收缩压(SBP)、心率(HR)、休克指数(shock index,SI)、rSI、GCS评分、SIA(SI×年龄)、SIG(SI×GCS评分)、rSIG和rSIG/A(rSIG/年龄)等临床指标,分析它们与患者预后的关系。结果两独立样本非参数检验(曼-惠特尼U检验)分析得出年龄、GCS评分、SIG、rSIG、rSIG/A对住院病死率有显著预测价值,用受试者工作特征曲线(ROC)下的面积(AUC)表明其预测敏感度及特异度。GCS的AUC为0.861(0.829~0.890),敏感度为74.68%,特异度为88.45%,预测价值最优;rSIG/A的AUC为0.842(0.809~0.872),敏感度为70.89%,特异度为90.41%,且与年龄的预测价值差异有统计学意义。<55岁组中,rSIG/A的AUC为0.859(0.813~0.897),敏感度为76.47%,特异度为88.21%;≥55岁组中,rSIG/A的AUC为0.817(0.764~0.862),敏感度为71.11%,特异度为86.36%。其中≥55岁组rSIG/A的诊断标准为≤0.196,<55岁组的rSIG/A诊断标准为≤0.300,需要更加关注高龄患者的SBP情况。结论对急诊一二级创伤患者来讲,rSIG/A是一个很强的预测住院死亡的指标,且在急诊分诊时容易计算。Objective To explore the prognostic value of age-adjusted rSIG,which is the reverse shock index(rSI)multiplied by Glasgow Coma Scale(GCS),in the prognosis of first-level and second-level traumatic patients admitted to the Emergency Department.Methods A retrospective analysis was made to evaluate the basic data of all first-level and second-level trauma patients admitted to the Emergency Department in our hospital from January 2020 to December 2020,there were a total of 538 cases,including 400 males and 138 females.According to in-hospital death as the outcoming,the patients were divided into the survivors and the non-survivors.The variables including gender,age,systolic blood pressure(SBP),heart rate(HR),shock index(SI),rSI,GCS score,SI multiplied by age(SIA),SI multiplied by GCS score(SIG),rSI multiplied by GCS score(rSIG)and rSIG divided by age(rSIG/A)between survivors and non-survivors were compared to determine the relationship of the vital signs with in-hospital mortality.Results In Mann-Whitney U test,age,GCS score,SIG,rSIG and rSIG/A had statistically significant associations with in-hospital mortality.The area under the receiver operating characteristic curve(AUC)was used to measure its discriminating ability.The AUC of GCS was 0.861(0.829-0.890),the sensitivity was 74.68%,and the specificity was 88.45%.The predictive value was the best.The AUC of rSIG/A was 0.842(0.809-0.872),the sensitivity was 70.89%,and the specificity was 90.41%.And they were significantly different from age.In the patients aged<55 years,the AUC of rSIG/A was 0.859(0.813-0.897),the sensitivity was 76.47%,and the specificity was 88.21%;in the patients aged≥55 years,the AUC of rSIG/A was 0.817(0.764-0.862),the sensitivity was 71.11%,and the specificity was 86.36%.The diagnostic criteria for rSIG/A in the≥55-year-old group was≤0.196,and the diagnostic criteria for rSIG/A in the<55-year-old group was≤0.300,which required us to pay more attention to the SBP of the elderly patients.Conclusions To the first-level and the second-leve

关 键 词：GCS评分 休克指数 一二级创伤患者 rSIG除以年龄(rSIG/A) 预后 

分 类 号：R641[医药卫生—外科学]