血清CK、Mb联合血乳酸预测多发伤患者短期预后的价值  

Value of serum CK and Mb combined with blood lactic acid in predicting short-term prognosis of patients with multiple injuries

作　　者：周志兰[1] 黄虎翔[2] 李炎[1] ZHOU Zhilan;HUANG Huxiang;LI Yan(Department of Laboratory,Huanggang Central Hospital,Huanggang Hubei 438000,China)

机构地区：[1]黄冈市中心医院检验科,湖北黄冈438000 [2]黄冈市中心医院呼吸内科,湖北黄冈438000

出　　处：《中国急救复苏与灾害医学杂志》2024年第8期1046-1049,1059,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：省卫生健康委关于下达2019-2020年度科研立项项目(编号:WJ2019M089)。

摘　　要：目的研究血清肌酸激酶(CK)、肌红蛋白(Mb)联合血乳酸预测多发伤患者短期预后的价值。方法回顾性分析黄冈市中心医院2019年9月—2022年9月收治的78例多发伤患者的临床资料,根据30 d后临床结局,将患者分为预后良好组(存活,共68例)及预后不良组(死亡,共10例)。收集患者一般资料,包括性别、年龄、受伤部位、受伤原因、心率、平均动脉压(MAP)、有无急诊插管、有无急诊心脏复苏术(CPR)、急诊输血次数,检测两组CK、Mb及血乳酸水平。比较两组临床资料差异;通过ROC分析CK、Mb及血乳酸预测多发伤短期预后不良的价值;以一致性分析CK、Mb及血乳酸联合预测多发伤短期预后不良的准确率;将两组有差异信息纳入Logistic模型,行量化赋值,明确多发伤预后不良的危险因素。结果预后良好组CK、Mb、血乳酸水平均明显低于预后不良组(P<0.05),预后良好组MAP≤90 mmHg、急诊插管、急诊CPR人数明显少于预后不良组(P<0.05)。两组在性别构成、年龄、受伤部位、受伤原因、心率、急诊输血次数方面无统计学差异(P>0.05)。经ROC分析证实CK、Mb及血乳酸能够预测多发伤短期预后不良,曲线下面积为0.625、0.783、0.796,均有P<0.05。联合检测采用串联试验,经一致性分析,CK、Mb及血乳酸联合预测多发伤短期预后不良的灵敏度0.800,特异度0.985,准确率96.20%,Kappa=0.820。将两组有差异信息纳入Logistic模型,行量化赋值,证实MAP≤90mmHg、急诊插管、急诊CPR、CK≥729.375μg/L、Mb≥358.260 U/L、血乳酸≥2.955 mmol/L是多发伤短期预后不良的危险因素(P<0.05)。结论CK、Mb、血乳酸均可预测多发伤患者短期预后不良,且三者联合能够更好预测多发伤患者短期预后不良。Objective To investigate the value of serum creatine kinase(CK)and myoglobin(Mb)combined with blood lactic acid in predicting short-term prognosis of patients with multiple injuries.Methods Clinical data of 78 patients with multiple injuries admitted to Huanggang Central Hospital from September 2019 to September 2022 were retrospectively analyzed.According to the clinical outcome 30 days later,the patients were divided into good prognosis group(survival,68 cases)and poor prognosis group(death,10 cases).Collected general data of patients,including gender,age,injury site,injury cause,heart rate,mean arterial pressure(MAP),emergency intubation,emergency CPR and emergency transfusion times,and detected CK,Mb and blood lactic acid levels in the two groups.The clinical data of the two groups were compared.The value of CK,Mb and blood lactic acid in predicting short-term poor prognosis of multiple injuries was analyzed by ROC.Consistency was used to analyze the accuracy of CK,Mb and blood lactate combined to predict the short-term poor prognosis of multiple injuries.The difference information of the two groups was incorporated into the Logistic model,and quantitative assignment was performed,to identify the risk factors for poor prognosis of multiple injuries.Results The levels of CK,Mb and blood lactic acid in the good prognosis group were significantly lower than those in the poor prognosis group(P<0.05),and the number of MAP≤90 mmHg,emergency intubation and emergency CPR in the good prognosis group was significantly lower than that in the poor prognosis group(P<0.05).There were no significant differences in gender composition,age,injury site,injury cause,heart rate and emergency transfusion times between the two groups(P>0.05).ROC analysis proved that CK,Mb and blood lactic acid could predict short-term poor prognosis of multiple injuries,and the areas under the curve were 0.625,0.783 and 0.796,all with P<0.05.The joint detection adopts a series test,and through consistency analysis,the sensitivity of CK,Mb,and blo

关 键 词：多发伤 血乳酸 肌酸激酶 肌红蛋白 预后 

分 类 号：R459.7[医药卫生—急诊医学]