血乳酸水平联合创伤严重程度评分对创伤性骨折致失血性休克患者的预后预测分析  

Prognostic Analysis of Blood Lactate Level Combined with Trauma Degree Score in Patients with Hemorrhagic Shock Caused by Traumatic Fracture

作　　者：徐加强 李清国 XU Jiaqiang;LI Qingguo(Department of Emergency Sub-Center,Lanling County People’s Hospital,Linyi 277700,China;Department of Osteoarthrosis,Lanling People’s Hospital,Linyi 277700,China)

机构地区：[1]山东省兰陵县人民医院急救分中心,山东临沂277700 [2]山东省兰陵县人民医院骨关节外科,山东临沂277700

出　　处：《中国伤残医学》2024年第17期46-49,共4页Chinese Journal of Trauma and Disability Medicine

摘　　要：目的:探讨血乳酸水平联合创伤严重程度评分(ISS)对创伤性骨折致失血性休克患者的预后预测效果。方法:回顾性分析2020年3月—2023年3月兰陵县人民医院收治的84例创伤性骨折致失血性休克患者的临床资料,根据其治疗28 d的预后情况分为生存组(n=65)与死亡组(n=19)。收集两组一般资料、实验室指标及入院时、入院后6、12、24 h血清乳酸水平与ISS,进行单因素及多因素Logistic回归分析,筛选独立预测因子。绘制受试者操作特征曲线(ROC),比较单独血乳酸水平、ISS及二者联合应用对于创伤性骨折致失血性休克患者预后的预测价值。结果:死亡组平均动脉压(MAP)低于存活组,入院后12、24 h血乳酸水平及ISS、急性生理与慢性健康状况评分系统-II(APACHE-Ⅱ)评分均高于存活组,差异均有统计学意义(P<0.05)。Logistic回归显示,MAP、入院后12 h血乳酸水平、ISS、APACHE-Ⅱ评分为影响创伤性骨折致失血性休克患者预后的独立预测因子(P<0.05)。ROC曲线分析显示:入院12 h血清乳酸水平联合ISS评分对创伤性骨折致失血性休克患者不良预后有一定的预测作用,且联合预测曲线下面积高于单个变量的AUC。结论:MAP、入院后12 h血乳酸水平、ISS、APACHE-Ⅱ评分是创伤性骨折致失血性休克患者预后的影响因素,血乳酸水平联合ISS评分预测创伤性骨折致失血性休克患者预后的准确性优于单个指标,具有较高诊断价值。Objective:To investigate the prognostic effect of blood lactate level combined with injury severe score(ISS)in patients with hemorrhagic shock caused by traumatic fracture.Methods:The clinical data of 84 patients with hemorrhagic shock caused by traumatic fracture admitted to Lanling County People’s Hospital from March 2020 to March 2023 were retrospectively analyzed,and they were divided into a survival group(n=65)and a death group(n=19)according to their prognosis after 28 days of treatment.General data,laboratory indicators,serum lactate level and ISS at admission and 6,12 and 24 h after admission were collected in the two groups.Univariate and multivariate Logistic regression analysis was performed to screen independent predictors.Receiver operating characteristic curve(ROC)was plotted to compare the predictive value of blood lactic acid level alone,ISS and their combination in patients with hemorrhagic shock caused by traumatic fracture.Results:The mean arterial pressure(MAP)of the death group was lower than that of the survival group,the blood lactic level and ISS,APACHE-Ⅱscore of Acute Physiology and Chronic Health Evaluation-Ⅱat 12 and 24 h after admission were higher than those of the survival group,with statistical significance(P<0.05).Logistic regression showed that MAP,blood lactate level 12 h after admission,ISS and APACHE-Ⅱscore were independent predictors of prognosis in patients with hemorrhagic shock caused by traumatic fracture(P<0.05).ROC curve analysis showed that serum lactate level combined with ISS score at 12 h after admission had a certain predictive effect on poor prognosis of patients with hemorrhagic shock caused by traumatic fracture,and the combined predictive area under the curve was higher than that of a single variable.Conclusion:MAP,blood lactic level 12 h after admission,ISS,APACHE-Ⅱscore are the prognostic factors of patients with hemorrhagic shock caused by traumatic fracture,the accuracy of blood lactic acid level combined with ISS score in predicting prognosis of p

关 键 词：创伤性骨折 失血性休克 血乳酸水平 创伤严重程度评分 

分 类 号：R687.3[医药卫生—骨科学]