重症创伤患者ICU早期输血治疗相关影响因素分析与预测评分系统构建  

Analysis of influencing factors and construction of predictive scoring system related to early blood transfusion in ICU for severe trauma patients

作　　者：来永光 李倩 毛永彬 矫海燕 徐学慧[1] 徐峰 尚鲁强 张百俊 LAI Yong-guang;LI Qian;MAO Yong-bin(ICU Department,Pingdu People's Hospital,Pingdu 266700,China)

机构地区：[1]平度市人民医院ICU,266700 [2]青岛市中心血站,266071

出　　处：《中国实用医药》2022年第25期40-43,共4页China Practical Medicine

基　　金：青岛市输血协会科技支持项目(项目编号:2020-qdsx01)。

摘　　要：目的 分析重症创伤患者重症加强护理病房(ICU)早期输血治疗相关影响因素,构建输血预测评分系统,并评价其性能。方法 回顾性分析入ICU 24 h内输血治疗的66例重症创伤患者的临床资料,构建预测评分模型,并进行受试者工作特征(ROC)曲线分析。结果 661例患者中,大量输血72例,非大量输血589例。大量输血与非大量输血患者年龄、性别比较差异无统计学意义(P>0.05);大量输血患者受伤至入ICU时间长于非大量输血患者,体温(T)、收缩压(SBP)、格拉斯哥昏迷量表(GCS)评分、血红蛋白(Hb)、血小板计数(PLT)、pH值、碱剩余(BE)、纤维蛋白原(FIB)低于非大量输血患者,心率(HR)、休克指数(SI)、创伤严重程度(ISS)评分、乳酸值(Lac)、国际标准化比值(INR)、持续出血占比、入ICU 24 h内输注红细胞数量、总输血量高于非大量输血患者,差异具有统计学意义(P<0.05)。对相关因素分别进行预测输血总量、输注红细胞数量的线性回归分析,结合临床工作实际,并经过多组合多重线性回归分析显示:SI、ISS评分、Hb、Lac、FIB、持续性出血情况为预测重症创伤患者ICU早期输血治疗所需输血总量、输注红细胞数量的独立影响因素(P<0.05)。在多重线性回归分析确定的独立影响因素基础上,对因素进行相应赋值,构建大量输血评分模型,以期快速、简便的判断大量输血几率,构建的大量输血预测评分系统设计总分1~8分。重症创伤患者ICU早期大量输血预测评分系统的ROC曲线下面积(AUC)为0.961,特异度为82.68%,敏感度为98.61%,约登指数为0.8129,对应的截断值>3分。结论 重症创伤患者ICU早期大量输血预测评分系统可以有效预测重症创伤患者入ICU早期输血治疗所需输血量,并能够有效地预测大量输血发生率,指导重症创伤患者临床精准输血治疗,减少临床不合理输血率,降低输血风险。Objective To analyze the influencing factors of early blood transfusion in the intensive care unit(ICU) of severe trauma patients, construct a predictive scoring system to evaluate its performance.Methods The clinical data of 66 patients with severe trauma who were treated with blood transfusion within 24 h of admission to the ICU were retrospectively analyzed, and a predictive scoring model was constructed for receiver operating characteristic(ROC) curve analysis. Results Among the 661 patients, 72 cases received massive blood transfusion and 589 cases received non-massive blood transfusion. There was no statistically significant difference in age and gender between patients with massive blood transfusion and patients with non-massive blood transfusion(P>0.05). The time from injury to ICU admission in patients with massive blood transfusion was longer than that in patients without massive blood transfusion;the body temperature(T), systolic blood pressure(SBP),Glasgow coma scale(GCS) score, hemoglobin(Hb), platelet count(PLT), pH, base excess(BE), fibrinogen(FIB) in patients with massive blood transfusion were lower than those in patients with non-massive blood transfusion;the heart rate(HR), shock index(SI), injury severity score(ISS), lactate(Lac) value, international normalized ratio(INR),percentage of persistent bleeding, number of red blood cells transfused within 24 h of ICU admission, and the total amount of blood transfusion in patients with massive blood transfusion were higher than those in patients with non-massive transfusion;the differences were all statistically significant(P<0.05). The linear regression analysis of predicting the total amount of blood transfusion and the number of transfused red blood cells was carried out on the relevant factors, combined with the actual clinical work, and the multi-combination multiple linear regression analysis showed that SI, ISS, Hb, Lac, FIB, and persistent bleeding status were the independent influencing factors to predict the total amount of blood transfusi

关 键 词：重症创伤 重症加强护理病房 早期输血 影响因素 预测评分系统 

分 类 号：R641[医药卫生—外科学]