电烧伤患者弥散性血管内凝血风险预测模型的建立与验证  

Establishment and validation of a risk prediction model for disseminated intravascular coagulation patients with electrical burns

作　　者：李全[1] 巴特[1] 曹胜军[1] 陈强[1] 周彪[1] 闫增强[1] 侯智慧[1] 王凌峰[1] Li Quan;Ba Te;Cao Shengjun;Chen Qiang;Zhou Biao;Yan Zengqiang;Hou Zhihui;Wang Lingfeng(Department of Burn Surgery,Baogang Hospital of Inner Mongolia,Burn Medical Institute of Inner Mongolia,Baotou 014010,China)

机构地区：[1]内蒙古包钢医院烧伤外科,内蒙古烧伤医学研究所,包头014010

出　　处：《中华烧伤与创面修复杂志》2023年第8期738-745,共8页Chinese Journal of Burns And Wounds

基　　金：内蒙古自然科学基金项目(2021MS08066、2020MS03022);重大疾病防治科技行动计划(2018-ZX-01S-001);中国金属学会冶金安全与健康分会科研项目(JKWS201832、JKWS202033);内蒙古医科大学科技百万工程联合项目[YKD2017KJBW(LH)048]。

摘　　要：目的通过筛选电烧伤患者发生弥散性血管内凝血(DIC)的独立危险因素,建立发生DIC风险预测模型并进行验证。方法采用回顾性病例系列研究方法。收集2015年1月—2023年1月内蒙古包钢医院收治的符合入选标准的218例电烧伤患者临床资料,其中男198例、女20例,年龄(38±14)岁。按照治疗期间是否被诊断为DIC,将患者分为DIC组和非DIC组。收集并比较2组患者一般临床资料,包括年龄、性别、烧伤总面积、Ⅲ度烧伤面积、致伤电压、伤后1 d内是否发生骨筋膜室综合征、烧伤重症监护病房停留时间、总住院时间,是否合并吸入性损伤、多发伤和入院时是否发生休克,简明烧伤严重指数评分与急性生理学和慢性健康状况评价Ⅱ评分;患者入院24 h内的实验室检测指标资料,包括血常规指标:白细胞计数(WBC)、血红蛋白水平、血小板计数(PLT)、中性粒细胞计数,凝血指标:活化部分凝血活酶时间(APTT)、凝血酶原时间、凝血酶时间、D-二聚体水平、纤维蛋白原(FIB)水平,血生化指标:天冬氨酸转氨酶、丙氨酸转氨酶、直接胆红素、总胆红素、总蛋白、白蛋白、血糖、肌酐、尿素氮的水平,血气分析指标:血pH值、动脉血氧分压、动脉血二氧化碳分压、碳酸氢根、碱剩余,心肌酶谱指标:肌红蛋白、肌钙蛋白、乳酸脱氢酶、肌酸激酶和α-羟丁酸脱氢酶的水平。对数据行χ^(2)检验、Fisher确切概率法检验、独立样本t检验、Mann-Whitney U检验。对单因素分析差异有统计学意义的变量采用最小绝对值压缩和选择算法(LASSO)回归进行降维处理,筛选218例电烧伤患者发生DIC的预测因子。将前述预测因子纳入多因素logistic回归分析,寻找218例电烧伤患者发生DIC的独立危险因素并绘制预测模型列线图。通过受试者操作特征(ROC)曲线和ROC曲线下面积评估预测模型性能,采用校准曲线和临床决策曲线分析法(DCA)Objective To establish and validate a risk prediction model of disseminated intravascular coagulation(DIC)by the screening independent risk factors for the occurrence of DIC in patients with electrical burns.Methods The retrospective case series study was conducted.The clinical data of 218 electrical burn patients admitted to Baogang Hospital of Inner Mongolia from January 2015 to January 2023 who met the inclusion criteria were collected,including 198 males and 20 females,with the age of(38±14)years.The patients were divided into DIC group and non DIC group based on whether they were diagnosed with DIC during the treatment period.The following data of patients of two groups were collected and compared,including age,gender,total burn area,full-thickness burn area,injury voltage,whether osteofascial compartment syndrome occurred within 1 day after injury,duration of stay in burn intensive care unit,total length of hospital stay,whether combined with inhalation injury and multiple injuries,whether shock occurred upon admission,the abbreviated burn severity index score,and the acute physiology and chronic health evaluationⅡscore.The laboratory examination data of the patients within 24 hours after admission were also collected,including blood routine indexes:white blood cell count(WBC),hemoglobin level,platelet count(PLT),and neutrophil count;coagulation indexes:activated partial thromboplastin time(APTT),prothrombin time,thrombin time,and levels of D-dimer and fibrinogen(FIB);blood biochemistry indexes:aspartic transaminase,alanine transaminase,direct bilirubin,total bilirubin,total protein,albumin,blood glucose,creatinine,and urea nitrogen;blood gas analysis indexes:blood pH value,arterial partial pressure of oxygen,arterial partial pressure of carbon dioxide,bicarbonate,and base excess;and cardiac zymogram indexes:levels of myoglobin,troponin,lactate dehydrogenase,creatine kinase(CK),andα-hydroxybutyrate dehydrogenase.Data were statistically analyzed with chi-square test,Fisher's exact probability test,indepe

关 键 词：烧伤 电 列线图 预后 危险因素 弥散性血管内凝血 D-二聚体 

分 类 号：R647[医药卫生—外科学]