肋骨骨折评分和肋骨评分对创伤性肋骨骨折患者伤情的评估价值及对不良预后事件的预测效能研究  

Rib fracture score and rib score for evaluating injury severity and predicting adverse events in patients with traumatic rib fractures

作　　者：靳贺 危朝辉 张琦 孙俊峰 杨宝升 罗世兰 曹芳 刘国栋 Jin He;Wei Chaohui;Zhang Qi;Sun Junfeng;Yang Baosheng;Luo Shilan;Cao Fang;Liu Guodong(Department of Cardiothoracic Surgery,926th Hospital of PLA Joint Logistics Support Force,Kaiyuan,Yunnan 661600,China;Department of Burns and Plastic Surgery,926th Hospital of PLA Joint Logistics Support Force,Kaiyuan,Yunnan 661600,China;War Trauma Medical Center,Daping Hospital,Army Medical University,Chongqing 400042,China)

机构地区：[1]解放军联勤保障部队第九二六医院心胸外科,云南开远661600 [2]解放军联勤保障部队第九二六医院烧伤整形外科,云南开远661600 [3]陆军军医大学大坪医院战创伤医学中心,重庆400042

出　　处：《创伤外科杂志》2023年第6期437-442,共6页Journal of Traumatic Surgery

基　　金：科技强院专项科研计划(926YY22XK07)。

摘　　要：目的 探讨肋骨骨折评分(rib fracture score, RFS)与肋骨评分(rib score, RS)对创伤性肋骨骨折患者的伤情评估价值及对不良预后事件的预测效能。方法 回顾性分析2020年1月—2021年12月解放军联勤保障部队第九二六医院心胸外科收治创伤性肋骨骨折患者137例,男性93例,女性44例;年龄13~83岁,平均50.2岁。RFS和RS为两种用于创伤性肋骨骨折患者伤情评估及预后预测的评分。依据患者是否存在肺挫伤分为肺挫伤组(82例)和无肺挫伤组(55例)。采用Wilcoxon秩和检验比较发生肺部感染、呼吸衰竭以及呼吸不良事件患者与未发生以上情况患者的RFS和RS分值差异,分析两种评分对患者伤情的评估价值。运用受试者工作特征(receiver operating characteristic, ROC)曲线及曲线下面积(area under the curve, AUC)分析两种评分对发生肺部感染、呼吸衰竭的预测效能。结果 伤情评估方面,全部患者中发生呼吸不良事件、肺部感染与呼吸衰竭患者RFS分值[12(7,18)、12(7,18)和13(8,19)]及RS分值[2(1,4)、3(1,4)和2(2,4)]均较未发生呼吸不良事件、未发生肺部感染与未发生呼吸衰竭患者高[RFS分值:5(3,9)、7(4,11)和6(3,11);RS分值:0(0,2)、1(0,2)和1(0,2)],差异有统计学意义(P<0.05)。不良预后事件预测方面,全部患者应用RS预测呼吸不良事件、肺部感染及呼吸衰竭时的AUC分别为0.776、0.753、0.768,均大于应用RFS的患者(0.742、0.695、0.765)。肺挫伤组预测呼吸不良事件及肺部感染方面,应用RS时的AUC(0.719、0.694)大于应用RFS(0.677、0.634),预测呼吸衰竭方面,应用RFS时AUC(0.728)大于应用RS(0.722)。无肺挫伤组,预测呼吸不良事件及肺部感染方面,应用RFS时的AUC(0.816、0.818)大于应用RS(0.772、0.721),预测呼吸衰竭方面,应用RS时的AUC(0.794)大于应用RFS(0.767)。结论 RFS和RS可用于创伤性肋骨骨折患者的伤情评估,伴有肺挫伤患者中,RS对呼吸不良事件及肺部感染的预�Objective To investigate the value of rib fracture score(RFS)and rib score(RS)for evaluating injury severity and predicting adverse events in patients with traumatic rib fractures.Methods Clinical data of 137 patients with traumatic rib fractures admitted to the Department of Cardiothoracic Surgery of 926th Hospital of PLA Joint Logistics Support Force from Jan.2020 to Dec.2021 were retrospectively analyzed.There were 93 male and 44 female aged 13-83 years,mean 50.2 years.RFS and RS,two scoring systems for injury evaluation and prognosis prediction in patients with traumatic rib fractures,were calculated for all the patients enrolled.Patients were divided into two groups according to the presence or absence of pulmonary contusion,respectively pulmonary contusion group(n=82)and non-pul-monary contusion group(n=55).RFS and RS were compared between patients with or without pneumonia,respiratory failure and respiratory adverse events by Wilcoxon rank sum test,so as to analyze the value of RFS and RS in injury evaluation.Receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to analyze the predictive efficacy of RFS and RS for incidence of pneumonia,respiratory failure and respiratory adverse events.Results In terms of injury evaluation,the patients with respiratory adverse events,pneumonia and respiratory failure showed a significantly higher RFS[12(7,18),12(7,18)and 13(8,19)]and RS[2(1,4),3(1,4)and 2(2,4)]than those without[RFS:5(3,9),7(4,11)and 6(3,11);RS:0(0,2),1(0,2)and 1(0,2)(all P<0.05).For all the patients,the AUC of RS in predicting respiratory adverse events,pneumonia and respiratory failure was 0.776,0.753 and 0.768,respectively,higher than that of RFS(0.742,0.695 and 0.765).In pulmonary contusion group,the AUC of RS(0.719 and 0.694)was greater than that of RFS(0.677 and 0.634)in predicting respiratory adverse events and pneumonia,but smaller in predicting respiratory failure(0.722 vs.0.728).In non-pulmonary contusion group,the results were different:RFS showed a higher AUC(0.816

关 键 词：肋骨骨折 创伤评分 伤情评估 不良事件 预测 

分 类 号：R655.1[医药卫生—外科学]