原矛头腹蛇咬伤继发患肢感染早期风险预测模型研究  

Prediction model of early risk of limb infection secondary to trimersurus mucrosquamatus snakebite

作　　者：罗杰 赵乙汜[1] 钟欣 吴豪杰 阙婉舒 徐昉[1] Luo Jie;Zhao Yisi;Zhong Xin;Wu Haojie;Que Wanshu;Xu Fang(Department of Critical Care Medicine,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400042,China;Emergency Department,Chongqing Emergency Medical Center,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属第一医院重症医学科,重庆400016 [2]重庆市急救医疗中心急诊科,重庆400014

出　　处：《中华急诊医学杂志》2022年第11期1515-1520,共6页Chinese Journal of Emergency Medicine

基　　金：重庆市科卫联合医学科研项目(2022QNXM063)。

摘　　要：目的探讨原矛头腹蛇咬伤患者患肢感染风险的早期预测的方法。方法回顾性收集重庆市急救医疗中心2019年1月至2020年10月,四肢原矛头腹蛇咬伤住院患者108例,根据后期治疗期间是否继发感染分为感染组(23例)和非感染组(85例),对比两组临床特征及入院前血清指标,筛选出感染风险因素;通过联合所有上述方法中筛选出风险因素评分、同时根据蛇咬伤严重程度评分(snakebite severity scale,SSS)、外观评分构建预测模型,对比三种预测模型在两组患者中差异,通过受试者工作特征曲线(receiver operating characteristic,ROC)评估三种预测模型对原矛头腹蛇咬伤患者患肢感染风险的预测价值。结果两组患者临床特征及入院前血清指标中受伤时间、是否为手足指(趾)受伤、水肿评分、是否存在张力性水疱、是否存在皮下出血、入院血小板计数差异有统计学意义(P<0.05)。构建的三种预测模型得分救过,在感染组与非感染组间差异有统计学意义(P<0.05)。在通过ROC曲线评估三种模型对蛇咬伤后后期感染风险的预测价值中,风险因素数的预测AUC值为0.830(95%CI:0.635~0.850),截断值2.5、敏感度0.870、特异度0.671,预测价值最佳。结论以风险因素数为标准的预测模型能有效预测蛇咬伤患者感染风险,风险因素数≥3分,提示感染风险大,可作为指导临床治疗方案的依据,值得推广。Objective To explore the method of early prediction of the risk of limb infection in patients bitten by trimersurus mucrosquamatus snake.Methods Totally 108 inpatients with limbs bitten by trimersurus mucrosquamatus snake in Chongqing Emergency Medical Center from January 2019 to October 2020 were respectively collected.They were divided into the infection group(23 cases)and non infection group(85 cases)according to whether they had secondary infection in the course of the disease.The clinical characteristics and serum indexes before admission were compared between the two groups to screen out the risk factors of infection.By combining all the above methods,the risk factor score was screened out;and the prediction model was constructed according to the snake bite severity score(SSS)and appearance score.The differences of the three prediction models between the two groups of patients were compared,and the predictive value of the three prediction models for the risk of limb infection in patients bitten by trimersurus mucrosquamatus snake was evaluated through the receiver operating characteristic(ROC)curve.Results There were significant differences in clinical characteristics and serum indexes before admission,injury time,hand and foot finger injury,edema score,tension blister,subcutaneous hemorrhage and admission platelet count between the two groups(P<0.05).The scores of the three predictive models differed between the two groups(P<0.05).The ROC curve was used to evaluate the predictive value of the three models for the risk of infection in the course of the disease.The predictive AUC value of the risk factors score was 0.830(95%CI:0.635-0.850),the cutoff value was 2.5,the sensitivity was 0.870 and the specificity was 0.671,which was the best in the three prediction models.Conclusions The prediction model based on the risk factors can effectively predict the infection risk of snake bite patients.It indicates that the infection risk is high when the score of risk factors≥3 points,which can be used as the basis f

关 键 词：蛇咬伤 感染风险 预测模型 原矛头腹蛇 

分 类 号：R646[医药卫生—外科学]